In early reports of percutaneous transluminal coronary angioplasty (PTCA) in women, the complication rate was higher and the success rate lower than in men. From December, 1980, to December, 1986, 969 women aged 61 (32-84) years and 2,727 men aged 57 (27-84) years underwent PTCA, at our institution. At the time of PTCA 26% of the women had functional class IV angina pectoris compared to 16% of the men (P less than 0.005). Women more often had hypertension (56% vs 39%), left ventricular hypertrophy, diabetes mellitus (19% vs 11%; P less than 0.0005), and family history of coronary artery disease than men. Significantly more of the men (74%) smoked than did the women (53%). The success rate in women was 93% as compared to an angiographic success rate in 2,727 men of 93.5% (ns). The rate of emergency bypass surgery in women was 3.8% as compared to 3.2% in men (ns). The death rate was 0.3% in women as compared to 0.09% in men. Women underwent more PTCA of the left anterior descending coronary artery (52% vs 48% of lesions in men; P less than 0.05) and right coronary artery (32% vs 27% in men; P less than 0.0005). Fewer of the women (9%) had had previous bypass surgery than had the men (15% P less than 0.0005). Procedural details, including balloon diameter, vessel diameter, lesion response pressure, inflation number, and maximum inflation pressures used as PTCA, were not different between men and women. Women had significantly more ST segment shift of 1 mm of more at the time of balloon inflation than men (P less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)