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Gabani R, Spione F, Arevalos V, Grima Sopesens N, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Gender Differences in 10-Year Outcomes Following STEMI: A Subanalysis From the EXAMINATION-EXTEND Trial. JACC Cardiovasc Interv 2022; 15:1965-1973. [PMID: 36008267 DOI: 10.1016/j.jcin.2022.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether gender plays a role in very long term outcomes. OBJECTIVES The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by gender. METHODS EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to gender. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age. RESULTS Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints. CONCLUSIONS At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and gender-specific risk factor control and targeted treatment. (10-Years Follow-Up of the EXAMINATION Trial [EXAMINAT10N]; NCT04462315).
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Affiliation(s)
- Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Thandra A, Jhand A, Guddeti R, Pajjuru V, DelCore M, Lavie CJ, Alla VM. Sex Differences in Clinical Outcomes Following Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28:25-31. [PMID: 32873519 DOI: 10.1016/j.carrev.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) has emerged as a reasonable alternative to coronary artery bypass graft (CABG) surgery in well-selected patients with unprotected left main coronary disease (LMCD). We conducted a systematic review and meta-analysis with the aim of assessing the impact of sex on outcomes of PCI in patients with unprotected LMCD. METHODS A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the outcomes of men vs. women among patients undergoing PCI for unprotected LMCD. The primary outcome of interest was study defined major adverse cardiac events (MACE) and secondary outcomes were all-cause mortality, cardiac mortality, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis and stroke. For all outcomes, pooled odds ratios (OR) with their corresponding 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model. RESULTS Six studies with a total of 6515 individuals (4954 men, 1561women) with a mean follow up of 36 months were included in the analysis. MACE and MI were significantly higher in women with OR of 1.17 (95% CI 1.01-1.36; p = 0.03) and 1.42 (95% CI 1.07-1.87; p = 0.01) respectively. All-cause mortality, cardiac mortality, and TLR were similar among men and women. CONCLUSION Our meta-analysis suggests that women undergoing PCI for unprotected LMCD have higher rates of MACE and MI compared to men.
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Affiliation(s)
- Abhishek Thandra
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA.
| | - Aravdeep Jhand
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Raviteja Guddeti
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Venkata Pajjuru
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Michael DelCore
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Venkata M Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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Flores-Umanzor EJ, Cepas-Guillen PL, Caldentey G, Pérez-Fuentes P, Arévalos V, Ivey-Miranda J, Regueiro A, Freixa X, Brugaletta S, Farrero M, Andrea R, Roquè M, Ferreira-González I, Martin-Yusté V, Sabaté M. Sex-based differences in chronic total occlusion management and long-term clinical outcomes. Int J Cardiol 2020; 319:46-51. [PMID: 32512058 DOI: 10.1016/j.ijcard.2020.05.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sex differences in coronary artery disease presentation and outcomes have been described. The aim of this study was to compare sex disparities in chronic total occlusion (CTO) management and long-term outcomes. METHODS All consecutive patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortality were assessed during a median follow-up of 4.03 years (IQR 2.6-4.8). RESULTS A total of 1248 patients (67.3 ± 10.9 years; 16% female) were identified. Women were older, had a higher prevalence of type 2 DM and a lower ventricle ejection fraction compared to men (p < .05). Although women had major proportion of positive result for severe ischemia-viability test (86% vs. 74%; p = .01), they were more often treated with MT alone compared to male (57% vs 51%; p = .02). During follow-up, 386 patients (31%) died. Women presented a higher rate of all-cause and cardiac mortality, and hospitalizations for heart failure independently of treatment strategy, compared to men (p < .001). In multivariable analysis female sex was associated with higher cardiac mortality [HR 1.67, 95% CI 1.10-2.57; p < .001]. Among women, the independent predictors for all-cause and cardiac mortalities were age, MT of the CTO and ACEF (age, creatinin and ejection fraction) score. CONCLUSIONS A significant sex gap regarding CTO treatment was observed. Female sex was an independent predictor for cardiac mortality at long-term follow-up. More data are needed to support these findings.
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Affiliation(s)
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Guillem Caldentey
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain; Cardiology department, Hospital del Mar (Consorci Mar Parc de Salut de Barcelona), Barcelona, Spain
| | - Pedro Pérez-Fuentes
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Victor Arévalos
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Juan Ivey-Miranda
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Mercé Roquè
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'hebron Hospital, Barcelona and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Victoria Martin-Yusté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain; Service de Cardiologie, Centre Hospitalier de Saintonge, Saintes, France.
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain.
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Zheng H, Foo LL, Tan HC, Richards AM, Chan SP, Lee CH, Low AF, Hausenloy DJ, Tan JW, Sahlen AO, Ho HH, Chai SC, Tong KL, Tan DS, Yeo KK, Chua TS, Lam CS, Chan MY. Sex Differences in 1-Year Rehospitalization for Heart Failure and Myocardial Infarction After Primary Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:1935-1940. [PMID: 30979413 DOI: 10.1016/j.amjcard.2019.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
It is unclear whether universal access to primary percutaneous coronary intervention (pPCI) may reduce sex differences in 1-year rehospitalization for heart failure (HF) and myocardial infarction (MI) after ST-elevation myocardial infarction (STEMI). We studied 7,597 consecutive STEMI patients (13.8% women, n = 1,045) who underwent pPCI from January 2007 to December 2013. Cox regression models adjusted for competing risk from death were used to assess sex differences in rehospitalization for HF and MI within 1 year from discharge. Compared with men, women were older (median age 67.6 vs 56.0 years, p < 0.001) with higher prevalence of co-morbidities and multivessel disease. Women had longer median door-to-balloon time (76 vs 66 minutes, p < 0.001) and were less likely to receive drug-eluting stents (19.5% vs 24.1%, p = 0.001). Of the medications prescribed at discharge, fewer women received aspirin (95.8% vs 97.6%, p = 0.002) and P2Y12 antagonists (97.6% vs 98.5%, p = 0.039), but there were no significant sex differences in other discharge medications. After adjusting for differences in baseline characteristics and treatment, sex differences in risk of rehospitalization for HF attenuated (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.79 to 1.40), but persisted for MI (HR 1.68, 95% CI 1.22 to 2.33), with greater disparity in patients aged ≥60 years (HR 1.83, 95% CI 1.18 to 2.85) than those aged <60 years (HR 1.45, 95% CI 0.84 to 2.50). In conclusion, in a setting of universal access to pPCI, the adjusted risk of 1-year rehospitalization for HF was similar in both sexes, but women had significantly higher adjusted risk of 1-year rehospitalization for MI, especially older women.
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Bjerking LH, Hansen KW, Sørensen R, Prescott E, Biering-Sørensen T, Jeger R, Kaiser C, Pfisterer M, Galatius S. Drug-eluting stents in large coronary vessels improve both safety and efficacy compared with bare-metal stents in women: a pooled analysis of the BASKET-PROVE I and II trials. Open Heart 2019; 6:e000986. [PMID: 31217999 PMCID: PMC6546185 DOI: 10.1136/openhrt-2018-000986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/20/2019] [Accepted: 04/26/2019] [Indexed: 01/05/2023] Open
Abstract
Background Drug-eluting stents (DES) have proven superior to bare-metal stents (BMS) in terms of safety and efficacy. However, inference to the female subgroup has been limited by low enrolment rates of women in clinical trials. The objective of this study was to investigate the safety and efficacy of DES versus BMS in women and men. Methods In a pooled analysis of two all-comers randomised trials (Basel Stent Kosten-Effektivitäts Trial-Prospective Validation Examination (BASKET-PROVE) and BASKET-PROVE II) (n=4605), we examined safety and efficacy of DES versus BMS according to sex. Patients were followed 2 years for a composite endpoint of cardiac death, non-fatal myocardial infarction (MI) and clinically driven target-vessel revascularisation not related to MI. Results Among the 1076 women and 3529 men included in the analysis, 65.6% of the women and 67.2% of the men were randomised to receive DES. At baseline, men had more complex coronary artery disease than women. After 2 years, DES reduced rates of major adverse cardiac events (MACE) compared with BMS in both women (cumulative incidence, 6.1% vs 14.7%; adjusted HR 0.36 (95% CI 0.24 to 0.54)) and men (7.7 vs 12.1%, HR 0.62 (0.50 to 0.77)), although the reduction in MACE rates was more pronounced in women (adjusted p=0.02 for sex-stent interaction). Event rates were lower in DES for both safety and efficacy outcomes, with the largest effect seen for non-MI TVR, in both women (2.3 vs 9.2%, adjusted HR 0.24 (0.13 to 0.44)) and men (4.0 vs 7.8%, adjusted HR 0.48 (0.36 to 0.64)) (adjusted p=0.049 for sex-stent interaction). Conclusions In patients requiring stenting of large coronary arteries, DES were associated with improved safety in women and superior efficacy in both sexes as compared with BMS.
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Affiliation(s)
| | - Kim Wadt Hansen
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev Gentofte University Hospital, Hellerup, Denmark
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Søren Galatius
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
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Gargiulo G, Ariotti S, Vranckx P, Leonardi S, Frigoli E, Ciociano N, Tumscitz C, Tomassini F, Calabrò P, Garducci S, Crimi G, Andò G, Ferrario M, Limbruno U, Cortese B, Sganzerla P, Lupi A, Russo F, Garbo R, Ausiello A, Zavalloni D, Sardella G, Esposito G, Santarelli A, Tresoldi S, Nazzaro MS, Zingarelli A, Petronio AS, Windecker S, da Costa BR, Valgimigli M. Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management: Data From the Randomized MATRIX-Access Trial. JACC Cardiovasc Interv 2019; 11:36-50. [PMID: 29301646 DOI: 10.1016/j.jcin.2017.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study sought to assess whether transradial access (TRA) compared with transfemoral access (TFA) is associated with consistent outcomes in male and female patients with acute coronary syndrome undergoing invasive management. BACKGROUND There are limited and contrasting data about sex disparities for the safety and efficacy of TRA versus TFA for coronary intervention. METHODS In the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) program, 8,404 patients were randomized to TRA or TFA. The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACCE or major bleeding. RESULTS Among 8,404 patients, 2,232 (26.6%) were women and 6,172 (73.4%) were men. MACCE and NACE were not significantly different between men and women after adjustment, but women had higher risk of access site bleeding (male vs. female rate ratio [RR]: 0.64; p = 0.0016), severe bleeding (RR: 0.17; p = 0.0012), and transfusion (RR: 0.56; p = 0.0089). When comparing radial versus femoral, there was no significant interaction for MACCE and NACE stratified by sex (pint = 0.15 and 0.18, respectively), although for both coprimary endpoints the benefit with TRA was relatively greater in women (RR: 0.73; p = 0.019; and RR: 0.73; p = 0.012, respectively). Similarly, there was no significant interaction between male and female patients for the individual endpoints of all-cause death (pint = 0.79), myocardial infarction (pint = 0.25), stroke (pint = 0.18), and Bleeding Academic Research Consortium type 3 or 5 (pint = 0.45). CONCLUSIONS Women showed a higher risk of severe bleeding and access site complications, and radial access was an effective method to reduce these complications as well as composite ischemic and ischemic or bleeding endpoints.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sara Ariotti
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Sergio Leonardi
- UOC Cardiologia, Dipartimento CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Frigoli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | | | - Paolo Calabrò
- Division of Cardiology, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Stefano Garducci
- Struttura complessa di Cardiologia ASST di Vimercate, Desio, Italy
| | - Gabriele Crimi
- UOC Cardiologia, Dipartimento CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
| | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino," University of Messina, Messina, Italy
| | - Maurizio Ferrario
- UOC Cardiologia, Dipartimento CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ugo Limbruno
- UO Cardiologia, Azienda USL Toscana Sudest, Grosseto, Italy
| | - Bernardo Cortese
- ASST Fatebenefratelli-Sacco, Milan, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Alessandro Lupi
- Cardiology Unit, University Hospital "Maggiore della Carità," Novara, Italy
| | - Filippo Russo
- Cardiovascular Interventional Unit, Cardiology Department, S.Anna Hospital, Como, Italy
| | - Roberto Garbo
- Interventional Cardiology Unit, Ospedale San Giovanni Bosco, Turin, Italy
| | | | | | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | | | | | - Anna Sonia Petronio
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Bruno R da Costa
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Yang J, Zhang F, Qian J, Ge L, Zhou J, Ge J. Sex-based influence on clinical outcomes after drug-eluting stent implantation in real-world patients: insight from the FOCUS registry. Ann Med 2017; 49:185-195. [PMID: 27607332 DOI: 10.1080/07853890.2016.1235283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To investigate the impact of sex on clinical outcomes after drug-eluting stent (DES) implantation in real-world patients. METHODS AND RESULTS A total number of 4720 patients (3365 males and 1355 females) undergoing the second-generation cobalt-chromium sirolimus-eluting stent (CoCr-SES) implantation from the FOCUS registry were included in this analysis. The cumulative incidences of major adverse cardiovascular event (MACE) (1.5% vs. 2.4%; p = .03), cardiovascular death (0.5% vs. 1.0%; p = .02) and target vessel revascularization (TVR) (0.3% vs. 0.8%; p = .01) within six months were significantly higher in females and the risks of MACE (adjusted hazard ratio [HR] 0.5 (0.3-0.9); p = .01) and TVR (adjusted HR 0.1(0.0-0.5); p = .001) remained significant in multivariate analysis. Reversely, the cumulative incidences of MACE (5.4% vs. 4.8%; p = .04) and any revascularization (5.1% vs. 3.3%; p = .01) were significantly higher in males beyond six months and the risks of all-cause death (adjusted HR 1.6 (1.1-2.5); p = .03) and cardiovascular death (adjusted HR 1.9 (1.1-3.6); p = .03) turned out to be significant in multivariate analysis. Notes: All cumulative incidences were presented as male vs. female; all HRs were calculated as male relative to female. CONCLUSIONS Females were associated with higher risk of early adverse events, while, males were associated with higher risk of late adverse events. Key messages Females undergoing PCI are typically older, have more cardiovascular risk factors, while, males in need of PCI are more frequently associated with complex lesions. The overall three-year cumulative incidences of adverse events are not significantly different between males and females but numerically higher in males. Females are associated with significantly higher risks of MACE and TVR within six months, while, males are associated with significantly higher risk of all-cause mortality and cardiac mortality beyond 6 months.
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Affiliation(s)
- Ji'e Yang
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Feng Zhang
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Juying Qian
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Lei Ge
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Jun Zhou
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Junbo Ge
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
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van Houwelingen KG, Lam MK, Löwik MM, Danse PW, Tjon Joe Gin RM, Jessurun GA, Anthonio RL, Sen H, Linssen GC, IJzerman MJ, Doggen CJ, von Birgelen C. Resultados de los stents Resolute Integrity y Promus Element en el infarto de miocardio: análisis del ensayo aleatorizado DUTCH PEERS (TWENTE II ). Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van Houwelingen KG, Lam MK, Löwik MM, Danse PW, Tjon Joe Gin RM, Jessurun GA, Anthonio RL, Sen H, Linssen GCM, IJzerman MJ, Doggen CJM, von Birgelen C. Outcome After Myocardial Infarction Treated With Resolute Integrity and Promus Element Stents: Insights From the DUTCH PEERS (TWENTE II) Randomized Trial. ACTA ACUST UNITED AC 2016; 69:1152-1159. [PMID: 27595181 DOI: 10.1016/j.rec.2016.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES In acute myocardial infarction (MI), novel highly deliverable drug-eluting stents (DES) may be particularly valuable as their flexible stent designs might reduce device-induced traumas to culprit lesions. The aim of the study was to assess the safety and efficacy of percutaneous coronary interventions with 2 novel durable polymer-coated DES in patients with acute MI. METHODS The prospective, randomized DUTCH PEERS (TWENTE II) multicenter trial compares Resolute Integrity and Promus Element stents in 1811 all-comer patients, of whom 817 (45.1%) were treated for ST-segment elevation MI or non-ST-segment elevation MI and the 2-year outcome is available in 99.9%. The primary clinical endpoint is target vessel failure (TVF), a composite of cardiac death, target vessel related MI, or target vessel revascularization. RESULTS Of all 817 patients treated for acute MI, 421 (51.5%) were treated with Resolute Integrity and 396 (48.5%) with Promus Element stents. At the 2-year follow-up, the rates of TVF (7.4% vs 6.1%; P = .45), target lesion revascularization (3.1% vs 2.8%; P = .79), and definite stent thrombosis (1.0% vs 0.5%; P = .69) were low for both stent groups. Consistent with these findings in all patients with acute MI, outcomes for the 2 DES were favorable and similar in both, with 370 patients with ST-segment elevation MI (TVF, 5.1% vs 4.9%; P = .81) and 447 patients with non-ST-segment elevation MI (TVF, 9.0% vs 7.5%; P = .56). CONCLUSIONS Resolute Integrity and Promus Element stents were both safe and efficacious in treating patients with acute MI. The present 2-year follow-up data underline the safety of using these devices in this particular clinical setting.
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Affiliation(s)
- K Gert van Houwelingen
- Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ming Kai Lam
- Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marije M Löwik
- Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Peter W Danse
- Cardiology Department, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Gillian A Jessurun
- Cardiology Department, Treant Zorggroep Location Scheper, Emmen, The Netherlands
| | - Rutger L Anthonio
- Cardiology Department, Treant Zorggroep Location Scheper, Emmen, The Netherlands
| | - Hanim Sen
- Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerard C M Linssen
- Cardiology Department, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Maarten J IJzerman
- Department Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Department Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Cardiology Department, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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Gargiulo G, Ariotti S, Santucci A, Piccolo R, Baldo A, Franzone A, Magnani G, Marino M, Esposito G, Windecker S, Valgimigli M. Impact of Sex on 2-Year Clinical Outcomes in Patients Treated With 6-Month or 24-Month Dual-Antiplatelet Therapy Duration. JACC Cardiovasc Interv 2016; 9:1780-9. [DOI: 10.1016/j.jcin.2016.05.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/14/2016] [Accepted: 05/28/2016] [Indexed: 12/31/2022]
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Chandrasekhar J, Mehran R. Sex-Based Differences in Acute Coronary Syndromes. JACC Cardiovasc Imaging 2016; 9:451-64. [DOI: 10.1016/j.jcmg.2016.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 01/22/2023]
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