DALLAS, September 29 -- Thanks to advances in technology, improved surgical techniques and possibly doctors' greater sensitivity to gender difference in heart disease, women now seem to do just as well as men after surgical procedures to restore blood flow to the heart.
In terms of both in-hospital deaths and five-year survival rates, a study in today's Circulation: Journal of the American Heart Association found no differences between men and women, although women often have more risk factors when they undergo cardiac bypass surgery or angioplasty. The results were the same for both "revascularization" procedures.
Since women often are sicker than men when revascularization is required, the results of this study can be considered even more dramatic, says the study's lead author, Alice K. Jacobs, M.D.
"This is good news for women," says Jacobs, of the Boston Medical Center. "The results of this study suggest that the outcome for women undergoing revascularization is improving."
Virtually every previous study showed that women did poorly compared to men after either bypass surgery or angioplasty.
In this latest research, based on 1,829 people in the Bypass Angioplasty Revascularization Investigation (BARI) -- a randomized trial of patients undergoing either bypass or angioplasty -- Jacobs and her colleagues found that both the in-hospital death rates and the five-year death rates were the same for both sexes. In the study, 27 percent of the participants were women. The women as a group were older by three years, and almost half were older than 65. Of those in the study, 1.3 percent of the women died in the hospital versus 1.4 percent of the men following bypass surgery, and just less than 1 percent (0.8) of women versus 1.2 percent of men died following angioplasty. There was no significant differences in the death rates.
Five years after revascularization, 87 percent of the women were still alive as were 88 percent of the men. Seventy-five percent of the women survived five years without another heart attack as did 77 percent of the men.
Jacobs sees several possible explanations for the new finding. One is the advances in surgical technology and techniques since the earlier studies were conducted. The BARI study, she says, came prior to the extensive use of newer technologies such as stents, which prop open blood vessels after angioplasty. The results might be even better now, she says.
"Being aware of the issues that are specific to women also may have contributed to the better outcome," she adds. Another possibility was that the women in the BARI study were somehow different from those in earlier studies.
"We cannot say for sure why the results are different. It's just an observation that they are different. We can recommend to women, with some enthusiasm, that they will have a reasonably good, acute and long-term outcome," she says.
Earlier studies show virtually all women undergoing bypass surgery had an in-hospital death rate 2 times that of men. The death rates were higher for women after angioplasty as well.
"All the studies have been extremely consistent in noting gender differences," says Jacobs. Women in the previous studies were older, had higher blood pressure, and had higher blood levels of cholesterol in addition to having more other serious diseases than men. More women than men in the studies had diabetes.
The study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.
Co-authors are Sheryl F. Kelsey, Ph.D. and Maria Mori Brooks, Ph.D. of the University of Pittsburgh; David P. Faxon, M.D., of the University of Southern California; Bernard R. Chaitman, M.D., St. Louis University; Vera Bittner, M.D., and Larry Dean, M.D., the University of Alabama at Birmingham; Michael M. Mock, M.D., the Mayo Clinic; Bonnie H. Weiner, M.D., University of Massachusetts Medical Center; Carla Winston, M.A., Stanford University; Laura Drew, R.N., Duke University Medical Center; and George Sopko, M.D., M.P.H, National Institutes of Health.
Media advisory: Dr. Jacobs can be reached by phone at (617) 638-8707, by fax at (617) 638-8712 or by e-mail at alice.jacobs@bmc.org. (Please do not publish numbers.)