Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization: insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial
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Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization: insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial. / Clemmensen, Peter; Roe, Matthew T; Hochman, Judith S; Cyr, Derek D; Neely, Megan L; McGuire, Darren K; Cornel, Jan H; Huber, Kurt; Zamoryakhin, Dmitry; White, Harvey D; Armstrong, Paul W; Fox, Keith A A; Prabhakaran, Dorairaj; Ohman, Erik Magnus; TRILOGY ACS Investigators.
in: AM HEART J, Jahrgang 170, Nr. 4, 10.2015, S. 695-705.e5.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization: insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial
AU - Clemmensen, Peter
AU - Roe, Matthew T
AU - Hochman, Judith S
AU - Cyr, Derek D
AU - Neely, Megan L
AU - McGuire, Darren K
AU - Cornel, Jan H
AU - Huber, Kurt
AU - Zamoryakhin, Dmitry
AU - White, Harvey D
AU - Armstrong, Paul W
AU - Fox, Keith A A
AU - Prabhakaran, Dorairaj
AU - Ohman, Erik Magnus
AU - TRILOGY ACS Investigators
N1 - Copyright © 2015 Elsevier Inc. All rights reserved.
PY - 2015/10
Y1 - 2015/10
N2 - BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin.METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27%) patients participating in a platelet function substudy.RESULTS: Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P = .56), all-cause mortality (12.2% vs 11.7%; P = .88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P = .74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity.CONCLUSIONS: Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.
AB - BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin.METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27%) patients participating in a platelet function substudy.RESULTS: Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P = .56), all-cause mortality (12.2% vs 11.7%; P = .88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P = .74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity.CONCLUSIONS: Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.
KW - Acute Coronary Syndrome/complications
KW - Aged
KW - Angina, Unstable/complications
KW - Clopidogrel
KW - Coronary Angiography
KW - Double-Blind Method
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Myocardial Infarction/diagnosis
KW - Myocardial Revascularization
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Prasugrel Hydrochloride/therapeutic use
KW - Purinergic P2Y Receptor Antagonists/therapeutic use
KW - Retrospective Studies
KW - Ticlopidine/analogs & derivatives
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.ahj.2015.06.011
DO - 10.1016/j.ahj.2015.06.011
M3 - SCORING: Journal article
C2 - 26386793
VL - 170
SP - 695-705.e5
JO - AM HEART J
JF - AM HEART J
SN - 0002-8703
IS - 4
ER -