Sex-Specific Considerations in Myocardial Revascularization Addressed in SCAI Expert Consensus Statement

February 4, 2022—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the publication of an expert consensus statement on sex-specific considerations in myocardial revascularization. The document aims to summarize the available literature on myocardial revascularization in women and identify important gaps in evidence.

The expert consensus statement by Alexandra Lansky, MD, et al is available online ahead of print in Journal of the Society for Cardiovascular Angiography and Interventions (JSCAI).

Dr. Lansky is Chair of the document writing committee, Editor-in-Chief of JSCAI, Professor of Medicine in the Section of Cardiology at Yale School of Medicine, and a practicing cardiologist at Yale New Haven Hospital in New Haven, Connecticut.

The paper explores gaps in evidence in several areas, including the epidemiology of ischemic heart disease, diagnostic tools to guide coronary revascularization, revascularization for chronic coronary syndromes, revascularization for non–ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction, and revascularization consideration for specific patient populations, vascular access in women, and more.

The authors of the paper state that although the evidence supporting clinical decisions in women is lacking, these findings are important to guide prospective investigation and establish research priorities.

“This consensus is an international collaborative effort that highlights the knowns, the gaps, and ambiguities in evidence related to sex-specific revascularization,” commented Dr. Lansky in the SCAI press release. “As a companion to the recent percutaneous coronary intervention guidelines, it will inform clinicians on best practices most relevant to our female patients and draw attention to areas in need of additional evidence.”

J. Dawn Abbott, MD, Co-Chair of the document, added, “Physicians can use this consensus document to inform their discussions with female patients on the risks and benefits of coronary revascularization. An understanding of the limitations of the data is important in this regard.” Dr. Abbott is Professor of Medicine and Director of the Interventional Cardiology Fellowship Training Program at the Warren Alpert Medical School of Brown University in Providence, Rhode Island.

According to the SCAI press release, use of cardiovascular procedures is far lower in women than men, and women continue to be underrepresented in cardiovascular clinical trials, severely limiting the opportunity to better understand sex differences in cardiovascular drug or device outcomes.

Current practice guidelines do not address sex-based differences and fail to highlight when insufficient evidence exists regarding cardiovascular outcomes in women, resulting in overall poorer outcome, noted SCAI.