ESTROGEN REPLACEMENT THERAPY AND OUTCOME OF CORONARY BALLOON ANGIOPLASTY IN POSTMENOPAUSAL WOMEN

Estrogen replacement therapy (ERT) in women after menopause is associa ted with prevention of clinical coronary artery disease. However, few studies have investigated possible benefits from ERT in postmenopausal women undergoing treatment for established coronary disease. We there fore retrospectively reviewed the clinical outcomes of 428 postmenopau sal women undergoing percutanious transluminal coronary balloon angiop lasty (PTCA) to test the hypothesis that ERT has a beneficial effect i n this setting. The women were divided into 2 groups based on ERT stat us at the time of the procedure, Estrogen users were younger (60 +/- 1 0 vs 68 +/- 9 years, p < 0.001), more commonly had family histories of coronary heart disease (54% vs 41%, p 0.84), had less incidence of;hy pertension (63% vs 76%, p = 0.02), and had slightly fewer diseased ves sels per patient (1.3 +/- 0.5 vs 1.5 +/- 0.7, p = 0.03) compared with nonusers. No in-hospital deaths occurred in estrogen users compared wi th 5% hospital mortality in nonusers (p = 0.01). The combined outcome of death or myocardial infarction (MI) also was lower in estrogen user s (4% vs 12%, p = 0.04), Of 348 women discharged after successful PTCA , 336 (97%) were able to be contacted at an average follow-up interval of 22 +/- 17 months (range 5 to 82), Estrogen users had superior even t-free survival both for death as well as for death or nonfatal MI. Re peat revascularizations were similar in both groups (32% vs 24%, p = 0 .15). In a Cox proportional-hazards model, nonusers had 4 times the li kelihood of death after angioplasty compared with estrogen users (OR = 4.025, 95% CI = 1.3 to 13.4, p = 0.02). We conclude that estrogen rep lacement may offer protection against clinical coronary events in post menopausal women who already have established coronary disease and are undergoing balloon angioplasty. The benefit was independent of age, s moking, presence of diabetes mellitus, or the number of diseased coron ary vessels. However, it did not include a reduction in repeat revascu larization procedures, suggesting no reduction in restenosis. (C) 1998 by Excerpta Medica, Inc.