Gender Differences With Acute Coronary Syndrome and Percutaneous Coronary Intervention
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This study was a retrospective multicenter observational study of 4851 patients age 55 years or younger (24% women) from the PROMETHEUS study, comparing outcomes in clopidogrel- and prasugrel-treated patients following percutaneous coronary intervention for acute coronary syndrome (ACS PCI). Women had a higher prevalence of diabetes (41.0 vs 27.9%) and chronic kidney disease (12.7 vs 7.2%) compared with men. Prasugrel use was lower in women compared with men (P = .01). The primary outcome was a composite of major adverse cardiac events (MACE), including death, myocardial infarction (MI), stroke, or unplanned revascularization. After 1 year, MACE (P < .001) and bleeding (P = .01) were significantly elevated in women compared with men; however, the differences were non-significant when adjusted for risk.
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Women, age 55 and younger, with ACS PCI had a higher prevalence of comorbidities compared with men. At 1 year, rates of MACE and bleeding were higher in women.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under-treatment. We sought to compare the 1-year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort.
METHODS
PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression.
RESULTS
The study cohort included 4851 patients of which 1162 (24.0%) were women and 3689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one-third of patients (31.8% in men vs. 28.1% in women, p = 0.01). Unadjusted, 1-year MACE (21.1% vs. 16.2%, p < 0.001) and bleeding (3.6% vs. 2.2%, p = 0.01) was significantly higher in women compared with men, but these results were no longer significant after adjustment for risk (HR 1.13, 95% CI 0.94-1.36 for MACE and HR 1.31, 95% CI 0.85-2.04 for bleeding).
CONCLUSION
Women younger than 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1-year MACE and bleeding than men, findings that are attributable to baseline differences.
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Additional Info
Sex-Related Differences in Outcomes Among Men and Women Under 55 Years of Age With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Results From the PROMETHEUS Study
Catheter Cardiovasc Interv 2016 May 06;[EPub Ahead of Print], J Chandrasekhar, U Baber, S Sartori, M Faggioni, M Aquino, A Kini, W Weintraub, S Rao, S Kapadia, S Weiss, C Strauss, C Toma, B Muhlestein, A DeFranco, M Effron, S Keller, B Baker, S Pocock, T Henry, R MehranFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.