Israeli study: Women four times more likely to die than men following emergency angioplasty

Prof. Ran Kronowsky – Angioplasty techniques need to be modified especially when facing patients who are problematic due to small vessles which have become calcified.Women who have suffered heart attacks and undergone emergency angioplasty are four times more likely to …

Prof. Ran Kronowsky – Angioplasty techniques need to be modified especially when facing patients who are problematic due to small vessles which have become calcified.Women who have suffered heart attacks and undergone emergency angioplasty are four times more likely to die within a month than men, according to Israeli researchers. This is a wake-up call for the 300,000 Americans who annually undergo the procedure, and may trigger research that could change cardiovascular care for women.

A study conducted at the Rabin Medical Center over the last three years shows that 11.3% of women who undergo percutaneous coronary intervention (otherwise known as emergency angioplasty) following a heart attack die within a month – compared to 2.5% of men.

According to the head of the Israeli team, Professor Ran Kronowsky – the head of the Interventional Cardiology Department at Rabin – the study covered more than 250 patients – 56 of them women – over a three year period. The study was presented in April at a conference of the Israel Heart Association by Kronowsky’s colleague Dr. Hanna Vaknin-Asa.

Angioplasty is also known as coronary artery balloon dilation, balloon angioplasty and percutaneous transluminal coronary angioplasty (PTCA). During the procedure, a balloon is inserted into the blocked artery through a catheter. The balloon is then inflated and deflated to clear the obstructions, and two mesh tubes, or stents, are inserted to keep the artery open. In recent years, it has become standard procedure to permanently place the stent inside the heart artery where the blockage was. The stent holds the artery open more widely and reduces the likelihood that the artery will renarrow in the same spot.

Previously, patients who were having heart attacks were treated with clot-busting drugs to unclog blocked coronary arteries and restore normal blood flow. Emergency angioplasty has been shown to be more effective than drugs in opening arteries and results in faster recoveries.

“Angioplasty is thought of today as the treatment of choice for patients who arrive at the hospital who are having a heart attack,” said Kronowsky. “But the data from our study is very surprising and very disturbing. It shows a tendency for higher mortality for women in the hospital and in a month’s range, the difference is four times higher for women.”

“We were troubled by the findings – we’re clearly not doing as well with women during heart attacks and emergency angioplasty compared to men,” he told ISRAEL21c. “We need to think of how to improve the mortality rate and to arrive at equal results between the sexes.”

The higher mortality rate for women heart attack victims is well documented by many studies worldwide. Researchers have provided many possible explanations, including the fact that women tend to suffer heart attacks at an older age than men, and that combined with other ailments of the elderly make them more susceptible.

There have been studies focusing on the comparative outcome in heart attacks and on outcomes of angioplasty. But according to Kronowsky, few studies have combined both – patients with heart attacks who are admitted to the hospital and undergo catheterization and making comparisons between the male and female patients.

“There wasn’t much data so we decided to explore our own experience,” said Kronowsky.

According to Kronowsky, a possible explanation for the higher mortality rate among women who undergo angioplasty than men derives from the fact that the arteries around the heart are smaller than men’s and more difficult to operate on during the procedure.

“Angioplasty techniques need to be modified especially when facing patients who are problematic due to small vessles which have become calcified. We saw much more of that among elderly women as compared to men,” he said.

Kronowsky said that the Rabin team intends to continue studying the subject with a larger study in order to gather more data.

“I hope that the subject of women’s heart attacks will be given a higher priority,” said Kronowsky.