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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

...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."

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.

Dr. Jennifer TremmelThe 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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