P2539Impact of sex (female vs male) in the ischemic-bleeding profile after hospital discharge for acute coronary syndrome during treatment with dual antiplatelet therapy

Introduction

Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. These differences could condition the treatment and prognosis of women compared to men with Acute Coronary Syndrome (ACS). The aim of our study was to determine, after matching the baseline characteristics of patients according to gender, the prognosis of women versus men during treatment with Dual Antiplatelet Therapy (DAPT), after an ACS undergoing Percutaneous Coronary Intervention (PCI).

Methods

The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients according to gender (female vs male). The impact of gender in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction, whereas for bleeding risk we have considered major bleeding defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal.

Results

From the 26,076 ACS patients, 6,091 were women PAD (23.4%). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), 640 had myocardial infarction (2.5%) and 685 had major bleeding (2.6%). After propensity-score matching, we obtained two matched groups (according gender) of 5,341 patients. In comparison with male, female had similar risk of myocardial infarction (sHR 1.14, 95% CI 0.91–1.44, p=0.001) with lower risk of major bleeding (sHR 0.75, 95% CI 0.61–0.92, p=0.006). The cumulative incidence of myocardial infarction was 26 and 30 per 1,000 patients/year in men and women, respectively, during DAPT. And the cumulative incidence of major bleeding was 43 and 32 per 1,000 patients/year in men and women, respectively. The difference between myocardial infarction rate and major bleeding rate was −17 in male (more bleeding than ischemic event rates; p<0.05) and +3 in women (similar bleeding and ischemic event rates; p>0.05), per 1,000 patient-years (Figure).

Figure 1

Conclusions

After an ACS underwent PCI, during DAPT, the ischemic-bleeding balance is different between women and men. In women, the annual incidence of ischemic events was similar to the incidence of bleeding events. However, in men, the incidence of bleeding events is higher than the incidence of ischemic events,