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Heartening news for women with cardiac problems

Although angioplasty may not be able to cure a broken heart, it does wonders in tackling blocked arteries. That became even more evident with the recent release of a DMS study about the outcomes of treating the literal kind of heart-break. David Malenka, M.D., an associate professor of medicine and of community and family medicine, has demonstrated that women who undergo angioplasty fare just as well as men in terms of their survival after the procedure.

Risk: This discovery eases concerns about how well cardiovascular disease is recognized and treated in women. Previous stud- ies, from the early 1990s, showed that women had a higher risk of adverse outcomes after angioplasty than men and a 64% higher mortality rate than men.

DMS cardiologist David Malenka has determined that women with blocked arteries now fare better than ever.
Photo: Mark Austin-Washburn

Procedures: But by the end of the 1990s, women's outcomes had changed dramatically. Malenka and a team of DMS researchers studied data from 33,666 cases of angioplasty and other artery-clearing procedures conducted in northern New England between 1994 and 1999. Their results were published in the Journal of the American College of Cardiology.

Malenka found that over the course of the study, the need to perform open-heart surgery and the rate of heart attacks after angioplasty for both women and men decreased significantly.

In addition, by the end of the study, women's overall rates had dropped so much that they virtually equalled those of men. By 1999, only 0.94% of women and 0.83% of men needed a coronary artery bypass graft, or CABG. Heart attack rates after angioplasty also decreased significantly— women's rates by 30% and men's by 38%. The rate of death after angioplasty stayed roughly the same for women and men, improving slightly for both.

Improvements: These improvements came despite the fact that over the course of the study, doctors were intervening on a sicker population—especially in the case of the women, who on average were slightly older than the men and had more complicating conditions, such as diabetes and vascular disease.

The reason for the improvement in outcomes between 1994 and 1999 is not exactly known, but Malenka believes the use of stents played a large part. Stents are wire mesh tubes which encircle the balloons used in angioplasty.

In angioplasty, a catheter with a balloon at its tip is inserted in or near a blockage in an artery, and the balloon is then inflated. That stretches the walls of the artery and cracks the plaque that is causing the blockage, thus restoring an adequate blood flow to the heart muscle. And as the balloon inflates, the stent around it also expands against the artery walls and helps to prevent restenosis—a recurrence of the blockage. Once the stent is in place, it remains there permanently.

Stents: In addition to stents, a few other elements have played a part in improving outcomes. "I do believe that the . . . CABG rate going down is due largely to the availability of stents, but not solely. We are better at selecting what lesions to tackle," says Malenka. Another factor is that "the catheters and balloons are . . . more reliably manufactured." And, he adds, better medications are available to help prevent clotting before and during arteryclearing procedures.

Scientists are now working on bonding medications to the stents to help heal blood vessels damaged during angioplasty. The medicated stents are expected to reduce restenosis rates to less than 5%. "That's going to be a very attractive option for people," predicts Malenka.

Matthew C. Wiencke

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