Specific Predictors of MACE in Patients With Premature CAD Undergoing PCI

Alexandra Murphy, MBBS, discusses a study looking at specific predictors of major adverse cardiac events (MACE) in patients with premature coronary artery disease undergoing percutaneous coronary intervention. Dr. Murphy presented the study results at the 2023 American College of Cardiology Scientific Sessions/World Cardiology Congress in New Orleans. Co-investigator and colleague Dr. Birgit Vogel discusses the state of care for young women at Mount Sinai's Women's Heart and Vascular Center.

The following transcript has been lightly edited for clarity.

Rebecca Kapur:

Welcome to Cath Lab Digest On Screen. I'm managing editor Rebecca Kapur. Today we're talking with Dr. Alexandra Murphy and Dr. Birgit Vogel of the Mount Sinai Hospital about their presentation at the American College of Cardiology and World Congress of Cardiology meeting in New Orleans. Dr. Murphy's group looked at sex-specific predictors of major adverse cardiovascular events, or MACE, in patients with premature CAD undergoing percutaneous coronary intervention. Thank you for joining us.

Alexandra Murphy, MBBS:

My name is Alexandra Murphy and I am a Fulbright Scholar and cardio-oncologist and general cardiologist. I'm currently working alongside Dr. Vogel at Mount Sinai in the Icahn Institute for Cardiovascular Research. I presented some research recently at the American College of Cardiology Conference in New Orleans, which is a real focus of our lab here, and it's where we do a lot of work on gender disparity in healthcare and in cardiology in particular. This was a patient-focused study rather than a physician-focused study, which Dr. Roxana Mehran has led. We looked at the predictors of major adverse cardiovascular events, or MACE, in young patients who undergo percutaneous coronary intervention (PCI). So the importance of this study, and the reason why it's a little bit different from other research that's been done in this area, is that we decided to select out from a very large database of over 4,000 patients, young patients, that this would be relevant to.

When we are thinking about coronary artery disease, young patients, there's a different definition for men and women. That's because of the difference in timing, that we see the distribution of timing of coronary artery disease developing in men versus women. So young is defined in men as under the age of 55 and women as under the age of 65. Selecting for that group, we had about 4,200 patients and about 45% of those were women. We had a look at not only at the major adverse cardiovascular events and the difference in the two groups to see once again that women are more likely to suffer an adverse event, but also we looked at the risk factors, the burden of comorbidity, and the differences between these two groups.

Interestingly, we found that the women that were included in this study were older, which is not that surprising, but they were much more co-morbid. They had a lot more risk factors, a lot more other medical conditions.This is a really, really important point to make, that women that are presenting with obstructive or symptomatic coronary artery disease do have very high risk profiles. That's something that we really need to address when we're thinking about prevention of coronary artery disease and improvement in the health status of men versus women.

Of the group we also found, interestingly, that when we looked at the risk factors that were most relevant to patients, there was actually a different hierarchy of risk factors for men versus women. Although there were some common factors that we have always understood as traditional cardiovascular risk factors that played a part in predicting their outcomes, we did find that race and other social determinants of health were much more important to women than to men. Using this information, I think we can take out of this, that we really need to target sex-specific directives to improve outcomes, rather than just having a one hat fits all kind of approach to public health models and preventative cardiology.

On this topic, I would really like to hand things over to my colleague Dr. Vogel, who is very highly versed and highly published in this area and has some interesting and new approaches that we have come up with to try and battle this disparity.

Birgit Vogel, MD:

Thank you so much, Dr. Murphy. I'm Birgit Vogel. I'm the Associate Director of Academic Affairs here at the Center for Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai. And I have a research focus on women and heart disease, as Dr. Murphy already mentioned, which is why I find this work very interesting and especially because it addresses a group of great importance, young women. Our study was done in a patient population that had already established coronary artery disease. But other studies have also shown that if women experience a cardiovascular event at a younger age, then they are at increased risk for worse outcomes compared to similarly aged men. So when we look at this young population, we find that they have a high burden of cardiovascular disease risk factors. We need to understand why there is not more screening in this population, a lot of which probably to do with the underestimation of cardiovascular risk in women.

I'm glad that now here at Mount Sinai, we have a specialized center, the Women's Heart and Vascular Center, that specializes in care for women. The focus is really to reduce the risk of heart disease later on in life by screening for cardiovascular risk factors. We know that there are some risk factors that are different from men. So there are specific risk factors in women that we want to address and recognize. For example, women with certain conditions during pregnancy, hypertensive disorders, or also diabetes in pregnancy, we know that they have higher risk later on in life to have heart disease. These women need follow-up, need screening for risk factors, and also treatment of risk factors. So I'm happy that this group of patients, or not really patients, but these young women, get increasingly more attention because this is how we can reduce the cardiovascular disease burden in women.

Rebecca Kapur:

Our thanks to Dr. Alexandra Murphy and Dr. Birgit Vogel. And thank you for joining us. Find more on cathlabdigest.com.