Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes
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Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes. / Schoos, Mikkel M; Mehran, Roxana; Dangas, George D; Yu, Jennifer; Baber, Usman; Clemmensen, Peter; Feit, Frederick; Gersh, Bernard J; Guagliumi, Giulio; Ohman, E Magnus; Pocock, Stuart J; Witzenbichler, Bernhard; Stone, Gregg W.
in: AM J CARDIOL, Jahrgang 118, Nr. 11, 01.12.2016, S. 1661-1668.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes
AU - Schoos, Mikkel M
AU - Mehran, Roxana
AU - Dangas, George D
AU - Yu, Jennifer
AU - Baber, Usman
AU - Clemmensen, Peter
AU - Feit, Frederick
AU - Gersh, Bernard J
AU - Guagliumi, Giulio
AU - Ohman, E Magnus
AU - Pocock, Stuart J
AU - Witzenbichler, Bernhard
AU - Stone, Gregg W
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Women are frequently reported to have increased morbidity after presentation with acute coronary syndromes and myocardial infarction; however, whether a greater thrombotic tendency contributes to gender differences in clinical outcomes of urgent percutaneous coronary intervention is unknown. Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials. We compared major adverse cardiac events (MACE) at in-hospital, 30-day, and 1-year follow-up and major bleeding at 30 days according to gender and the presence or absence of IPTE. IPTE was identified in 507 patients (7.7%), with 119 of 1,744 (6.8%) occurring in women and 388 of 4,847 (8.0%) in men (p = 0.12). IPTE, but not gender, was independently associated with MACE at in-hospital and 30-day follow-up. At 1-year follow-up, the adjusted hazard of MACE was higher in women and in patients with IPTE; however, the risk of MACE associated with IPTE was similar among women and men. There was no significant interaction between IPTE and gender for 1-year MACE or 30-day bleeding. IPTE predicted major bleeding only in women. In conclusion, in acute coronary syndromes, women have increased risk of adverse outcome at 1 year. IPTEs are common, occur at similar frequency, and are associated with similar degree of increased MACE in both genders at short- and long-term follow-up. Higher thrombotic propensity does not offer a mechanistic explanation for the worse outcomes noted in women.
AB - Women are frequently reported to have increased morbidity after presentation with acute coronary syndromes and myocardial infarction; however, whether a greater thrombotic tendency contributes to gender differences in clinical outcomes of urgent percutaneous coronary intervention is unknown. Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials. We compared major adverse cardiac events (MACE) at in-hospital, 30-day, and 1-year follow-up and major bleeding at 30 days according to gender and the presence or absence of IPTE. IPTE was identified in 507 patients (7.7%), with 119 of 1,744 (6.8%) occurring in women and 388 of 4,847 (8.0%) in men (p = 0.12). IPTE, but not gender, was independently associated with MACE at in-hospital and 30-day follow-up. At 1-year follow-up, the adjusted hazard of MACE was higher in women and in patients with IPTE; however, the risk of MACE associated with IPTE was similar among women and men. There was no significant interaction between IPTE and gender for 1-year MACE or 30-day bleeding. IPTE predicted major bleeding only in women. In conclusion, in acute coronary syndromes, women have increased risk of adverse outcome at 1 year. IPTEs are common, occur at similar frequency, and are associated with similar degree of increased MACE in both genders at short- and long-term follow-up. Higher thrombotic propensity does not offer a mechanistic explanation for the worse outcomes noted in women.
KW - Aged
KW - Antineoplastic Agents, Phytogenic
KW - Clopidogrel
KW - Coronary Angiography
KW - Drug-Eluting Stents
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Heparin/administration & dosage
KW - Hospital Mortality/trends
KW - Humans
KW - Incidence
KW - Intraoperative Complications/epidemiology
KW - Male
KW - Middle Aged
KW - New South Wales/epidemiology
KW - Paclitaxel/pharmacology
KW - Percutaneous Coronary Intervention/adverse effects
KW - Platelet Aggregation Inhibitors/administration & dosage
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Sex Distribution
KW - Sex Factors
KW - Survival Rate/trends
KW - Thromboembolism/epidemiology
KW - Ticlopidine/administration & dosage
KW - Time Factors
KW - United States/epidemiology
U2 - 10.1016/j.amjcard.2016.08.046
DO - 10.1016/j.amjcard.2016.08.046
M3 - SCORING: Journal article
C2 - 27836132
VL - 118
SP - 1661
EP - 1668
JO - AM J CARDIOL
JF - AM J CARDIOL
SN - 0002-9149
IS - 11
ER -
