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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
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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: jens.jensen@ks.se

Received 4 November 1999

Revised 14 February 2000

Accepted 25 February 2000

Conflict of interest: None.

© 2000 Lippincott Williams & Wilkins, Inc.