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March
29,
2010 -- 7:30pm EDT
Does Less Angioplasty in Women
Having a Heart Attack Lead to Worse Outcomes?
This was the conclusion of a much-publicized
study presented
at the American College of Cardiology meeting two weeks ago by French
cardiologist, Dr. Francois Schiele. The study of 3,000 patients
who were admitted to a hospital for a heart attack showed
that far fewer women were sent to the cath lab
for
an angiogram, angioplasty or stent. It also showed that women were
twice as likely to die within a month of the heart attack. Yet when
groups
of
men
and
women
who received
similar
treatments
were compared, there was no mortality difference, implying
that fewer women are being offered angioplasty: the interventional
treatment that is considered the
"gold standard" for heart attack .
One
possible reason was given by Dr. Rita Redberg, a cardiologist at the
University of California, San Francisco, as reported by theheart.org:
...the treatment gap between men and women
shown in the study could be caused by the perception among
interventionists that their female patients are more likely
to have complications with thrombolysis or angioplasty. She
pointed out that "there are pretty consistent data that
women have higher rates of procedural complications and higher
rates of bleeding complications than men. That could be limiting
some of the invasive treatments we are seeing."
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Dr. Schiele agreed and speculated whether the
rates of angiography and angioplasty in women could be safely increased
with better stents for smaller arteries, greater use of radial (wrist)
access and
better antithrombotic regimens.
Almost to answer the question, the current
issue of Cardiac
Interventions Today features two articles on the transradial approach. "The
role of radial artery access in the evolution of percutaneous angioplasty
and in minimizing complications" specifically discusses
how the use of the radial approach in patients with acute coronary
syndrome (ACS) and heart attack virtually eliminates procedural bleeding
complications, complications which have been
associated with increased mortality.
The
second article, "The
Transradial Approach: Does your fellowship training program teach it?",
is by Dr. Jennifer Tremmel, Director of Transradial Interventions at
Stanford Medical Center and Clinical Director of Women's
Heart Health at Stanford Clinic. In this she addresses the lack of
training in the radial approach during interventional fellowships in
the U.S. And Dr. Tremmel understands this problem first-hand. As she
told Angioplasty.Org in her
exclusive interview:
I knew that my women patients were more
prone to having bleeding complications. I could say to them, "Well,
you're more prone to having this problem," and they always
looked at me like, "So what are you going to do about
it?" and I couldn't really give them a good answer. The
answer certainly was not vascular closure devices because those
don’t decrease bleeding complication rates....
[Then] one day
I saw an article which said that both sexes have significantly
lower bleeding rates with transradial
intervention, particularly women.... So when I saw that, I
was like, "This
is it!".... I felt a real obligation to figure
out a way to lower bleeding complications just because I'm
a women's heart health specialist and that's my job: how do
I improve the outcomes of the women that I take care of? In
my mind, transradial was the answer. |
As a result, Dr. Tremmel flew to New York, took a transradial
course with Dr.
John Coppola, went back to Stanford -- and now does almost
all of her cases via the wrist with hardly any bleeding complications.
And with increased outcomes for her female patients.
Any cardiologist or fellow interested in the transradial
approach should definitely check out Dr. Tremmel's recent
article.
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