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Women react with more myocardial ischemia and angina pectoris during elective percutaneous transluminal coronary angioplasty

Jensen, Jens a; Eriksson, Sven V. b; Lindvall, Bo c; Lundin, Peter b; Sylvén, Christer a

Pathophysiology and Natural History

Background Women have been considered to be at higher risk of complications relating to percutaneous transluminal coronary angioplasty (PTCA) than are men. One reason for this sex-related difference could be the ischemic response of myocardium during the procedure.

Objective To investigate whether there are sex-related differences in ischemic response of myocardium during elective PTCA.

Methods Consecutive patients (n  = 192, of whom 48 were women), were subjected to vectorcardiography during the PTCA procedure. Vectorcardiographic variables, magnitude of ST-segment vector (ST-VM), and magnitude of ST-segment vector change (STC-VM) were studied.

Results Women were older (63 ± 10 versus 56 ± 10 years, P  < 0.001) than men in our study and more often had diabetes mellitus and hypertension. Women less often had stents implanted (24 versus 50%, P  < 0.01) and they were subjected to fewer balloon inflations (P  < 0.001), with a total inflation time shorter than that for men (P  < 0.001). Maximum STC-VM was 25% greater for women (P  < 0.05). Women reported greater maximum pain (P  < 0.05) and nitroglycerine was more frequently used for them during PTCA (P  < 0.05). Occurrence of episodes of residual ischemic STC-VM (the difference between total number of episodes and number of balloon inflations) was more common for women (3 ± 5 versus 1 ± 3, P  < 0.01). Duration of residual ischemic STC-VM episodes (the difference between total duration of episodes and duration of balloon inflations) was longer for women than it was for men (242 ± 275 versus 148 ± 233 s, P  < 0.05). In a stepwise multivariate analysis and for a matched case-control group, episodes of residual STC-VM and duration of residual STC-VM episodes still indicated that there was an independent sex-related difference (P  < 0.01 and P  < 0.01, respectively).

Conclusions Women more commonly develop vectorcardiographic signs of severe myocardial ischemia, more frequently experience episodes of ischemia and report more severe angina pectoris during elective PTCA than do men.

a Department of Cardiology, Huddinge Hospital, Huddinge, Sweden. b Department of Medicine, Danderyd Hospital, Danderyd, Sweden. c Department of Radiology, Huddinge Hospital, Huddinge, Sweden.

Correspondence and requests for reprints to Jens Jensen, MD, Department of Cardiology, Karolinska Hospital, S-171 76 Stockholm, Sweden. Tel: +46 8 517 76770; fax: +46 8 311044; e-mail:

Received 4 November 1999

Revised 14 February 2000

Accepted 25 February 2000

Conflict of interest: None.

© 2000 Lippincott Williams & Wilkins, Inc.