General Medical · Health

Coronary Artery Disease in Women: What Are the Options When an Artery Is Blocked?

There is a final subset of patients with stable or minimal symptoms who may warrant revascularization. Stress testing is utilized to identify patients in whom a large amount of heart muscle receives blood from arteries that have a high degree of blockage.  Patients with severely abnormal stress tests (see figure 2) have a limited capacity to respond to the stress of non-cardiac illnesses, and with an abundance of atherosclerotic plaque they are at high risk to develop plaque erosion or rupture that produces an ACS with potentially high mortality.  Such patients  are often referred for PCI when multiple blockages can safely receive stents, or CABG if the angiogram suggests that complete revascularization cannot be achieved by stenting.

UntitledFigure 2. Nuclear stress test from our office.  With exercise there is a large area at the top of the heart (red arrows) lacking blood flow that is much less apparent at rest (white arrows).  The responsible blockage was stented. (Source: James A. Blake, M.D)

Conclusion: The prognosis of women and men with coronary artery disease has continued to improve. Not all women with stable symptoms require revascularization; optimal medical management may be an excellent option, although a woman or her physician may prefer revascularization if quality of life is diminished, medication side effects are intolerable, or the coronary artery disease proves to be extensive on stress testing.  By contrast, women with unstable symptoms, particularly with an ACS connoted by abnormal blood enzymes, are best served with early revascularization.  An increased risk of such procedures noted in earlier studies has been attributed to more advanced age, diabetes, and hypertension, often with ventricular hypertrophy, in women who require these procedures.  Fortunately, the evolution of invasive techniques has resulted in a reduction in serious complications in both sexes treated with revascularization, narrowing the gender gap.  The choice of a high-volume center helps to further reduce complication rates, allowing women and men to safely derive the proven long-term benefits of these procedures.

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