Confusion in Revascularization: Are Women Different and Why?

Cardiovascular disease is the leading cause of death in women in most developed countries of the world. Even though cardiovascular deaths of men in the United States have been declining, until recently the number of cardiovascular deaths in US women was on the rise, with 1 in 3 women dying from heart disease. Over the last 30 years numerous studies have reported sex differences in the epidemiology, prevention, diagnosis, and clinical manifestations of coronary artery disease. A higher morbidity and mortality were also noted in women versus men undergoing revascularization during this early period. This has mainly been attributed to the fact that women have more comorbid conditions by the time that they are referred for revascularization. These conditions include increased age, hypertension, diabetes (metabolic syndrome), heart failure, renal disease, peripheral vascular disease, and worse lipid profile. With improvements of both surgical techniques and percutaneous coronary intervention, morbidity and mortality rates have decreased in women undergoing revascularization. However, there are now questions surrounding percutaneous coronary intervention strategies, particularly with drug eluting stents. More recent advances in coronary bypass graft surgery techniques, both off- and on-pump, and analysis of prospective and retrospective data have shown a clearly improved survival rate in patients undergoing coronary bypass graft surgery and the persistence of a durable result.