Details

Autor(en) / Beteiligte

• Schoos, Mikkel M., MD, PhD
• Mehran, Roxana, MD
• Dangas, George D., MD, PhD
• Yu, Jennifer, MBBS
• Baber, Usman, MD, MS
• Clemmensen, Peter, MD, DMSc
• Feit, Frederick, MD
• Gersh, Bernard J., MB, ChB, DPhil
• Guagliumi, Giulio, MD
• Ohman, E. Magnus, MD
• Pocock, Stuart J., PhD
• Witzenbichler, Bernhard, MD
• Stone, Gregg W., MD

Titel

Sex Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes (From the ACUITY and HORIZONS-AMI Trials)

Ist Teil von

• The American journal of cardiology, 2016

Erscheinungsjahr

2016

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Abstract 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 sex differences in clinical outcomes of urgent percutaneous coronary intervention is unknown. Intraprocedural Thrombotic Events (IPTE) 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. IPTE 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 sex and presence or absence of IPTE. IPTE was identified in 507 patients (7.7%), with 119/1,744 (6.8%) occurring in women and 388/4,847 (8.0%) in men (p=0.12). IPTE, but not sex, 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 sex 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 sexes at short and long term follow-up. Higher thrombotic propensity does not offer a mechanistic explanation for the worse outcomes noted in women.