Hormone Replacement Therapy After Angioplasty
Source: O’Keefe JH, et al. J Am Coll Cardiol 1997; 29:1-5.Since estrogen replacement therapy (ert) may have beneficial effects on coronary artery factors involved in restenosis, O’Keefe et al performed a retrospective observational study evaluating the effects of ERT in postmenopausal women undergoing coronary angioplasty. Among 2436 women undergoing elective angioplasty, two groups were compared: 137 on long-term ERT who met other study criteria (no previous revascularization, no acute MI) and 200 women computer-matched by age, left ventricular ejection fraction, number of diseased vessels, and completeness of revascularization.
During a mean follow-up of 65 months, actuarial seven-year survival in the ERT group was 93% vs. 75% for the control group (P = 0.001). This advantage of the ERT group was not explained by in-hospital complications following angioplasty (5-6% in both groups). Almost two-thirds of the deaths in the study were cardiac: six (4%) in the ERT group and 30 (15%) in the controls. Other causes of death were not significantly different between the two groups, nor were other cardiac events including stroke, repeat angioplasty, or bypass surgery.
The authors conclude that ERT was associated with better long-term survival after angioplasty. In this study, restenosis and other non-fatal outcomes were not affected—thus, the benefits of ERT on progression of vascular disease in general may have been magnified by picking a disease population undergoing angioplasty.
The major limitation of this study is that it is small and not randomized. The women on ERT may have been a healthier cohort. In fact, the proportion of patients with diabetes was higher in the control group than the ERT group (28% vs 18%; P = 0.04).
Although this study represents another observation in favor of ERT for postmenopausal women with coronary artery disease, definite conclusions await long-term randomized control trials. However, this study does not support the prevention of restenosis following angioplasty as a basis for ERT.—mhc