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Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non–ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

      The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non–ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.
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      References

        • O'Gara P.T.
        • Kushner F.G.
        • Ascheim D.D.
        • Casey Jr., D.E.
        • Chung M.K.
        • de Lemos J.A.
        • Ettinger S.M.
        • Fang J.C.
        • Fesmire F.M.
        • Franklin B.A.
        • Granger C.B.
        • Krumholz H.M.
        • Linderbaum J.A.
        • Morrow D.A.
        • Newby L.K.
        • Ornato J.P.
        • Ou N.
        • Radford M.J.
        • Tamis-Holland J.E.
        • Tommaso C.L.
        • Tracy C.M.
        • Woo Y.J.
        • Zhao D.X.
        • Anderson J.L.
        • Jacobs A.K.
        • Halperin J.L.
        • Albert N.M.
        • Brindis R.G.
        • Creager M.A.
        • DeMets D.
        • Guyton R.A.
        • Hochman J.S.
        • Kovacs R.J.
        • Ohman E.M.
        • Stevenson W.G.
        • Yancy C.W.
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2013; 61: e78-e140
        • Ahmed B.
        • Dauerman H.L.
        Women, bleeding, and coronary intervention.
        Circulation. 2013; 127: 641-649
        • Fuster V.
        • Moreno P.R.
        • Fayad Z.A.
        • Corti R.
        • Badimon J.J.
        Atherothrombosis and high-risk plaque: part I: evolving concepts.
        J Am Coll Cardiol. 2005; 46: 937-954
        • Stefanini G.G.
        • Baber U.
        • Windecker S.
        • Morice M.C.
        • Sartori S.
        • Leon M.B.
        • Stone G.W.
        • Serruys P.W.
        • Wijns W.
        • Weisz G.
        • Camenzind E.
        • Steg P.G.
        • Smits P.C.
        • Kandzari D.
        • Von Birgelen C.
        • Galatius S.
        • Jeger R.V.
        • Kimura T.
        • Mikhail G.W.
        • Itchhaporia D.
        • Mehta L.
        • Ortega R.
        • Kim H.S.
        • Valgimigli M.
        • Kastrati A.
        • Chieffo A.
        • Mehran R.
        Safety and efficacy of drug-eluting stents in women: a patient-level pooled analysis of randomised trials.
        Lancet. 2013; 382: 1879-1888
        • Shacham Y.
        • Topilsky Y.
        • Leshem-Rubinow E.
        • Laufer-Perl M.
        • Keren G.
        • Roth A.
        • Steinvil A.
        • Arbel Y.
        Comparison of left ventricular function following first ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in men versus women.
        Am J Cardiol. 2014; 113: 1941-1946
        • Steg P.G.
        • Huber K.
        • Andreotti F.
        • Arnesen H.
        • Atar D.
        • Badimon L.
        • Bassand J.P.
        • De Caterina R.
        • Eikelboom J.A.
        • Gulba D.
        • Hamon M.
        • Helft G.
        • Fox K.A.
        • Kristensen S.D.
        • Rao S.V.
        • Verheugt F.W.
        • Widimsky P.
        • Zeymer U.
        • Collet J.P.
        Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology.
        Eur Heart J. 2011; 32: 1854-1864
        • Yu J.
        • Mehran R.
        • Dangas G.D.
        • Claessen B.E.
        • Baber U.
        • Xu K.
        • Parise H.
        • Fahy M.
        • Lansky A.J.
        • Witzenbichler B.
        • Grines C.L.
        • Guagliumi G.
        • Kornowski R.
        • Wohrle J.
        • Dudek D.
        • Weisz G.
        • Stone G.W.
        Safety and efficacy of high- versus low-dose aspirin after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial.
        JACC Cardiovasc Interv. 2012; 5: 1231-1238
        • Pancholy S.B.
        • Shantha G.P.
        • Patel T.
        • Cheskin L.J.
        Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis.
        JAMA Intern Med. 2014; 174: 1822-1830
        • Allen L.A.
        • O'Donnell C.J.
        • Camargo Jr., C.A.
        • Giugliano R.P.
        • Lloyd-Jones D.M.
        Comparison of long-term mortality across the spectrum of acute coronary syndromes.
        Am Heart J. 2006; 151: 1065-1071
        • Hirsch A.
        • Verouden N.J.
        • Koch K.T.
        • Baan Jr., J.
        • Henriques J.P.
        • Piek J.J.
        • Rohling W.J.
        • van der Schaaf R.J.
        • Tijssen J.G.
        • Vis M.M.
        • de Winter R.J.
        Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris.
        Am J Cardiol. 2009; 104: 333-337
        • Lansky A.J.
        • Ng V.G.
        • Maehara A.
        • Weisz G.
        • Lerman A.
        • Mintz G.S.
        • De Bruyne B.
        • Farhat N.
        • Niess G.
        • Jankovic I.
        • Lazar D.
        • Xu K.
        • Fahy M.
        • Serruys P.W.
        • Stone G.W.
        Gender and the extent of coronary atherosclerosis, plaque composition, and clinical outcomes in acute coronary syndromes.
        JACC Cardiovasc Imaging. 2012; 5: S62-S72
        • Mehran R.
        • Pocock S.
        • Nikolsky E.
        • Dangas G.D.
        • Clayton T.
        • Claessen B.E.
        • Caixeta A.
        • Feit F.
        • Manoukian S.V.
        • White H.
        • Bertrand M.
        • Ohman E.M.
        • Parise H.
        • Lansky A.J.
        • Lincoff A.M.
        • Stone G.W.
        Impact of bleeding on mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trials.
        JACC Cardiovasc Interv. 2011; 4: 654-664
        • Amsterdam E.A.
        • Wenger N.K.
        • Brindis R.G.
        • Casey Jr., D.E.
        • Ganiats T.G.
        • Holmes Jr., D.R.
        • Jaffe A.S.
        • Jneid H.
        • Kelly R.F.
        • Kontos M.C.
        • Levine G.N.
        • Liebson P.R.
        • Mukherjee D.
        • Peterson E.D.
        • Sabatine M.S.
        • Smalling R.W.
        • Zieman S.J.
        2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 64: e139-e228
        • Berger J.S.
        • Elliott L.
        • Gallup D.
        • Roe M.
        • Granger C.B.
        • Armstrong P.W.
        • Simes R.J.
        • White H.D.
        • Van de Werf F.
        • Topol E.J.
        • Hochman J.S.
        • Newby L.K.
        • Harrington R.A.
        • Califf R.M.
        • Becker R.C.
        • Douglas P.S.
        Sex differences in mortality following acute coronary syndromes.
        JAMA. 2009; 302: 874-882