A local cardiology expert pointed out that Korean women with acute coronary syndrome are undertreated and receive delayed treatment compared to their male counterparts, requiring a different treatment approach.
Professor Kim Hyoung-oh from Kyung Hee University Medical Center stressed the importance of a differentiated treatment approach for women at the 16th Korean Society of Interventional Cardiology’s winter conference that was held at the Shilla Seoul Friday.
According to Kim, women are more likely to demonstrate atypical symptoms than men. A study by the team led by Kerry Milner from the Yale University School of Nursing showed that gender differences exist in symptom presentation of patients with coronary heart disease. The study by John Canto from the Watson Clinic and Lakeland Regional Medical Center emphasized that women were more likely than men to present atypical symptoms and had higher mortality than men within the same age group.
“Among the patients studied in various studies, men featured more frequent chest pain while women displayed more atypical symptoms such as vomiting, headache, and jaw and tooth pain, among others.,” said Professor Kim. “Because of this, studies show that reperfusion among STEMI patients as well as non-primary PCI were less frequently performed in women.”
Although studies show that invasive reperfusion significantly benefits both men and women, studies found women were treated in a delayed manner and undertreated in an acute setting, leading to worse clinical outcomes.
Kim pointed towards a local study that utilized data from the Korean Acute Myocardial Infarction Registry (KAMIR), which encompassed more than 4,000 ACS patients. The domestic research team led by Park Jong-seon from Yonsei University Medical School, Department of Internal Medicine, used KAMIR data to find that women had higher rates of in-hospital mortality, noncardiac death, cardiac death, and stroke than men. The team concluded that women have higher in-hospital mortality than men.
“Women patients should, therefore, be approached differently to gain the same treatment effects as men,” Kim said.
Kim noted that women also are more vulnerable to bleeding complications, thereby making them eligible for the radial approach for percutaneous coronary intervention (PCI).
“The female sex factor relatively increased bleeding complication rate among patients who underwent PCI and people who were medically treated,” said Kim. “Radial access can minimize bleeding complication rates, and is therefore preferable in women ACS patients.”
Finally, Kim pointed out that female ACS patients are more likely to show plaque erosion pathology when they are younger, thereby making them eligible for non-stent treatment.
“Studies have shown that younger female patients had a higher prevalence of plaque erosion that led to sudden coronary death, leading to the suggestion of utilizing non-stent treatment,” the professor said. “In younger ACS women patients, where plaque erosion was relatively elevated in vivo setting, non-stent treatment can be considered.”