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Minerva Cardioangiologica 2020 Apr 23

DOI: 10.23736/S0026-4725.20.05203-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

PCI in women: is sex still an issue?

Stéphane MANZO-SILBERMAN 1, 2

1 Service de Cardiologie, Hôpital Lariboisière, Université Paris, Paris, France; 2 UMRS 942, Paris, France


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INTRODUCTION: Coronary artery disease among women presents differences in terms of clinical presentation and pathophysiology. To date, women present worse prognoses with more events and higher mortality rate. One the one hand, they are less likely addressed for invasive therapy. One the other hand, revascularization procedures, whether by bypass or by percutaneous coronary intervention, are associated with higher rates of complications and poorer prognosis.
EVIDENCE ACQUISITION: Despite higher risk factor burden and comorbidity, women are less affected by obstructive disease and plaque characteristics are more favorable than among men. Abnormalities of endothelial function and micro vascular flow reserve could explain part of the high prevalence of symptoms of angina observed among women. Due to the worse prognosis of microvascular dysfunction, particularly in women, proper diagnosis is mandatory and deserve invasive management. Outcome following STEMI is still more severe among women with higher in-hospital mortality but sex discrepancies are observed even in elective PCI. However, improvement of techniques, drugs and devices benefited to both men and women and tend to decrease gender gap. Especially, changes in the design of newer generation DES may be particularly important for women. Female sex remains a potent predictor of higher risk of bleeding and vascular complication; thus important efforts should be promoted to develop bleeding avoidance strategies.
CONCLUSIONS: Sex-based differences still deserve dedicated investigations in terms of physiopathology, particular hormonal impacts, and specific responses to drugs and devices.


KEY WORDS: Women; PCI; Coronary disease; Bleeding; Stent

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