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Comment & Response
December 30, 2020

The 70/30 Rule Between Men and Women—Disparity or Opportunity?—Reply

Author Affiliations
  • 1Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Box Hill Hospital, Eastern Health Clinical School and Monash University, Melbourne, Australia
  • 3European Cardiovascular Research Center (CERC), Massy, France
  • 4Associate Editor, JAMA Cardiology
JAMA Cardiol. 2021;6(4):482-483. doi:10.1001/jamacardio.2020.6136

In Reply We thank Maggioni and Grego for their interest in our article.1 It is well established that percutaneous coronary intervention (PCI) trials include fewer women than men, often requiring pooled analyses to strengthen the observed associations. This may be in part because of lower prevalence of obstructive coronary artery disease in women but also because of significant comorbidities, such as older age, chronic kidney disease, and anemia, limiting their participation in randomized clinical trials (RCTs). Investigators may be driven by the first principle of doing no harm, and risk of bleeding or procedure-related acute kidney injury may have mitigated enthusiasm for trial recruitment of larger numbers of women to PCI studies. Maggioni and Grego also astutely raise delayed or wrong diagnoses in women with coronary syndromes as a potential problem affecting recruitment. Indeed, nonobstructive coronary artery disease in women presenting with acute coronary syndrome requires more attention; nevertheless, the assessment of novel coronary stents will not apply to this subset.

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