ESTROGEN REPLACEMENT THERAPY AFTER CORONARY ANGIOPLASTY IN WOMEN

Objectives. The purpose of this study was to assess the effects of est rogen replacement therapy on long-term outcome, including restenosis, myocardial infarction, stroke and death after a first percutaneous tra nsluminal coronary angioplasty (PTCA) procedure, in postmenopausal wom en. Background. Observational and epidemiologic studies, basic laborat ory research and clinical trials consistently suggest that estrogen re placement therapy is associated with beneficial cardio vascular effect s in women. These cardioprotective actions may be particularly relevan t to women with coronary artery disease, such as those who have underg one PTCA. Methods. This was a retrospective study that included 337 wo men who underwent elective PTCA between 1982 and 1994. The treatment g roup consisted of 137 consecutive women receiving long-term estrogen t herapy at the time of elective PTCA and during follow-up. The control group comprised 200 women who were computer-matched with the estrogen group. The mean follow-up period was 65 +/- 35 months. Results. Actuar ial survival was superior in the estrogen group; the 7-year survival r ate was 93% for the estrogen group versus 75% for the control group (p = 0.001). The cardiovascular event rate (death, nonfatal myocardial i nfarction or nonfatal stroke) was significantly lower in the estrogen group at 7 years (12% vs, 35% in the control group, p = 0.001). The ne ed for subsequent revascularization during follow up was similar in th e two groups. Multivariable analysis identified diabetes, estrogen the rapy (adjusted risk ratio 0.38, 95% confidence interval 0.19 to 0.79) and left ventricular ejection fraction <40% as independent correlates of cardiovascular death or myocardial infarction during follow up. Con clusions. Estrogen replacement therapy was associated with an improved long term outcome after PICA in postmenopausal women.