Are there gender differences or issues related to angiographic imaging of the coronary arteries?

The use of coronary angiography and coronary interventions in women with suspected coronary artery disease has recently come under close scrutiny. Clear differences in the utilization of these procedures, including coronary artery bypass graft (CABG) surgery have led to concerns that a bias may exist against the use of these procedures in women. Alternative explanations of these perceived practice differences have focused on their propriety based on patients' ages, underlying disease severity, expected prevalence of coronary disease and comorbid conditions rather than physician bias. The possibility that these procedures are over utilized in men has also been suggested. Pertinent to this debate are historical observational data suggesting that women may be at higher risk of major complications of coronary interventions and CABG surgery. Because coronary artery disease is the most frequent cause of death among women in the United States, there is some sociopolitical urgency in addressing these important concerns. This article reviews the use and findings of diagnostic coronary angiography in women with suspected coronary artery disease. Specific risks to women who have coronary angiography performed are also discussed. Finally, the outcome of percutaneous coronary revascularization procedures in women compared to men is discussed.