Impact of sex on long‐term cardiovascular outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes
2021; Wiley; Linguagem: Inglês
10.1002/ccd.29754
ISSN1522-726X
AutoresAnastasios Roumeliotis, Bimmer E. Claessen, Samantha Sartori, Davide Cao, Hanbo Qiu, Anton Camaj, Johny Nicolas, Rishi Chandiramani, Ridhima Goel, Mauro Chiarito, Rebecca Torguson, Joseph Sweeny, Nitin Barman, Prakash Krishnan, Annapoorna Kini, Samin K. Sharma, George Dangas, Roxana Mehran,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoCatheterization and Cardiovascular InterventionsVolume 98, Issue 4 p. E494-E500 ORIGINAL STUDIES Impact of sex on long-term cardiovascular outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes Anastasios Roumeliotis MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorBimmer E. Claessen MD, PhD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorSamantha Sartori PhD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorDavide Cao MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorHanbo Qiu, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorAnton Camaj MD, MS, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorJohny Nicolas MD, orcid.org/0000-0002-3015-3361 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRishi Chandiramani MD, orcid.org/0000-0001-8659-6850 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRidhima Goel MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorMauro Chiarito MD, orcid.org/0000-0002-9333-2658 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRebecca Torguson MPH, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorJoseph Sweeny MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorNitin Barman MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorPrakash Krishnan MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorAnnapoorna Kini MD, orcid.org/0000-0002-7189-3307 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorSamin K Sharma MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorGeorge Dangas MD, PhD, orcid.org/0000-0001-7502-8049 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRoxana Mehran MD, Corresponding Author roxana.mehran@mountsinai.org orcid.org/0000-0002-2012-4137 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA Correspondence Roxana Mehran, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA. Email: roxana.mehran@mountsinai.orgSearch for more papers by this author Anastasios Roumeliotis MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorBimmer E. Claessen MD, PhD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorSamantha Sartori PhD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorDavide Cao MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorHanbo Qiu, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorAnton Camaj MD, MS, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorJohny Nicolas MD, orcid.org/0000-0002-3015-3361 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRishi Chandiramani MD, orcid.org/0000-0001-8659-6850 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRidhima Goel MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorMauro Chiarito MD, orcid.org/0000-0002-9333-2658 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRebecca Torguson MPH, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorJoseph Sweeny MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorNitin Barman MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorPrakash Krishnan MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorAnnapoorna Kini MD, orcid.org/0000-0002-7189-3307 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorSamin K Sharma MD, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorGeorge Dangas MD, PhD, orcid.org/0000-0001-7502-8049 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USASearch for more papers by this authorRoxana Mehran MD, Corresponding Author roxana.mehran@mountsinai.org orcid.org/0000-0002-2012-4137 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA Correspondence Roxana Mehran, Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA. Email: roxana.mehran@mountsinai.orgSearch for more papers by this author First published: 25 May 2021 https://doi.org/10.1002/ccd.29754Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Background Women with acute coronary syndrome (ACS) generally present with more comorbidities and experience worse clinical outcomes compared with males. However, it is unclear whether this represents genuine sex-related difference or stems from clinical, procedural and socioeconomic factors. Methods We analyzed consecutive patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), non-STEMI or unstable angina at a single tertiary-care center. Exclusion criteria were unknown sex, age < 18 years and PCI with bare metal stent or without stent placement. The study population was stratified according to sex. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) defined as the composite of death, spontaneous myocardial infarction, or stroke at 1 year. Secondary endpoints were individual components of MACCE, target vessel revascularization (TVR) and clinically significant bleeding. Results Of the 7362 patients included, 5031 (68.3%) were men and 2331 (31.7%) women. Women were older and presented with a higher burden of comorbidities while men had more complex coronary anatomy. The incidence of 1 year MACCE was significantly higher among women (8.0% versus 5.6%; p < 0.01) compared to men. Women also experienced a higher rate of bleeding (2.3% vs. 1.4%; p = 0.02) while there were no differences between groups in terms of TVR (8.1% vs. 7.8%; p-value = 0.83). Differences in outcomes were attenuated after multivariable adjustment. Findings were consistent across ACS subgroups. Conclusions In a contemporary ACS population treated with drug-eluting stents, women experienced a higher crude rate of 1-year MACCE. This was no longer apparent after accounting for baseline imbalances. Open Research DATA AVAILABILITY STATEMENT Data available upon reasonable request to the authors. Supporting Information Filename Description ccd29754-sup-0001-FigureS1.tifTIFF image, 41.5 KB Supplementary Figure 1: Flowchart demonstrating target population selection and stratification. ACS: acute coronary syndrome, DES: drug eluting stent. ccd29754-sup-0002-FigureS2.tifTIFF image, 25.8 KB Supplementary Figure 2: Forest plot presenting adjusted HR at 1 year for the different endpoints in the UA population. The results were adjusted for age, race Caucasian, diabetes mellitus, chronic kidney disease, prior myocardial infarction, prior coronary artery bypass grafting, multivessel disease, total stent length, minimum stent diameter, B2C lesions complexity. Abbreviations: ACS: acute coronary syndrome, CI: confidence interval, HR: hazard ratio, MACCE: major adverse cardiac and cerebrovascular events, MACE: major adverse cardiac events, MI: myocardial infarction, TVR: target vessel revascularization, UA: unstable angina. ccd29754-sup-0003-FigureS3.tifTIFF image, 25.8 KB Supplementary Figure 3: Forest plot presenting adjusted HR at 1 year for the different endpoints in the NSTEMI population. The results were adjusted for age, race Caucasian, diabetes mellitus, chronic kidney disease, prior myocardial infarction, prior coronary artery bypass grafting, multivessel disease, total stent length, minimum stent diameter, B2C lesions complexity. Abbreviations: ACS: acute coronary syndrome, CI: confidence interval, HR: hazard ratio, MACCE: major adverse cardiac and cerebrovascular events, MACE: major adverse cardiac events, MI: myocardial infarction, TVR: target vessel revascularization NSTEMI: non ST-elevation myocardial infarction. ccd29754-sup-0004-FigureS4.tifTIFF image, 25.9 KB Supplementary Figure 4: Forest plot presenting adjusted HR at 1 year for the different endpoints in the STEMI population. The results were adjusted for age, race Caucasian, diabetes mellitus, chronic kidney disease, prior myocardial infarction, prior coronary artery bypass grafting, multivessel disease, total stent length, minimum stent diameter, B2C lesions complexity. Abbreviations: ACS: acute coronary syndrome, CI: confidence interval, HR: hazard ratio, MACCE: major adverse cardiac and cerebrovascular events, MACE: major adverse cardiac events, MI: myocardial infarction, TVR: target vessel revascularization STEMI: ST-elevation myocardial infarction. ccd29754-sup-0005-Tables.docxWord 2007 document , 30.7 KB Supplementary Table 1: Periprocedural and in-hospital events for Males vs. Females Supplementary Table 2: Comparison between males and females at the 30 days, 90 days and 1 year in the general acute coronary syndrome population. Supplementary Table 3: Comparison between males and females at the 30 days, 90 days and 1 year in the unstable angina population. Supplementary Table 4: Comparison between males and females at the 30 days, 90 days and 1 year in the non ST-segment myocardial infarction population. Supplementary Table 5: Comparison between males and females at the 30 days, 90 days and 1 year in the ST-segment myocardial infarction population. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume98, Issue4October 2021Pages E494-E500 SCAI Member Sign in RelatedInformation
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