Gender based differences in drug eluting stent implantation - data from the German ALKK registry suggest underuse of DES in elderly women

Ruß, Martin; Wackerl, Christian; Zeymer, Uwe; Hochadel, Matthias; Kerber, Sebastian; Zahn, Ralf; Zrenner, Bernhard; Topp, Hubert; Schächinger, Volker; Weber, Michael A.

doi:10.1186/s12872-017-0500-y

Cited by 16 publications

(13 citation statements)

References 33 publications

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“…Limited studies had also revealed that very elderly female ACS patients had received significantly less invasive angiography and timely revascularization [ 12 , 13 ] for higher mortality rates [ 12 , 14 ]. Furthermore, very elderly women treated with PCI for ACS were often excluded from large international clinical trials [ 15 , 16 ]. As a result, there are less clinical studies and clinical experiences of PCI procedure in this population.…”

Section: Introductionmentioning

confidence: 99%

Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

Wang

Guo

Chen

et al. 2021

BMC Cardiovasc Disord

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Background Whether very elderly women with acute coronary syndromes (ACS) should receive aggressive percutaneous coronary intervention (PCI) is still controversial. We assessed the effectiveness and long-term clinical outcomes of successful PCI in this population and identified prognostic factors which might contribute to the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the very elderly female PCI cohort. Methods Female ACS patients aged ≥ 80 years were consecutively enrolled (n = 729) into the study. All the patients were divided into female PCI group (n = 232) and medical group (n = 497). MACCE was followed up, including non-fatal myocardial infarction (MI), stroke, heart failure requiring hospitalization (HFRH), cardiovascular (CV) death, and the composite of them. After propensity score matching (1:1), the incidences of MACCE were compared between the two groups. Clinical and coronary artery lesion characteristics were compared between the female PCI patients with (n = 56) and without MACCE (n = 176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in the female PCI patients. MACCE of male PCI patients, who aged ≥ 80 years and hospitalized in the same period (n = 264), was also compared with that of the female PCI patients. Results A total of 32% very elderly female ACS patients received PCI in the present study. (1) Compared to female medical group, PCI procedure significantly alleviated the risks of MACCE: non-fatal MI (6.2% vs. 20.2%, P < 0.001), HFRH (10.9% vs. 22.5%, P = 0.012), CV death (12.4% vs. 28.7%, P < 0.001) and the composite MACCE (24.0% vs. 44.2%, P < 0.001) during the median follow-up period of 36 months. (2) Between very elderly female and male PCI patients, there were no significant differences in occurrence of MACCE (P = 0.232) and CV death (P = 0.951). (3) Multivariate Cox analysis revealed that ST-segment elevation myocardial infarction (STEMI) (HR 1.944, 95% CI 1.11–3.403, P = 0.02) and elevated log- N-Terminal pro-brain natriuretic peptide (NT-proBNP) (HR 1.689, 95% CI 1.029–2.773, P = 0.038) were independently associated with the incidence of MACCE in the female PCI patients. Conclusions PCI procedure significantly attenuated the risk of MACCE and improved the long-term clinical outcomes in very elderly female ACS patients. Aggressive PCI strategy may be reasonable in this population.

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Section: Introductionmentioning

confidence: 99%

Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

Wang

Guo

Chen

et al. 2021

BMC Cardiovasc Disord

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“…[ 8 ] Furthermore a tendency to use less effective treatment in female relative to male patients with CAD has been reported. [ 9 ] As consequence, treatment decisions are frequently based on overall outcomes. This is also the case for the evaluation of coronary stents.…”

Section: Introductionmentioning

confidence: 99%

A randomized multicenter trial comparing the XIENCE everolimus eluting stent with the CYPHER sirolimus eluting stent in the treatment of female patients with de novo coronary artery lesions: The SPIRIT WOMEN study

et al. 2017

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BackgroundThe comparative performance of different drug-eluting stents (DES) among female patients has not been assessed in a randomized manner.ObjectivesThe SPIRIT Women Clinical Evaluation trial compared the durable polymer everolimus-eluting XIENCE stent (DP-EES) with the durable polymer sirolimus-eluting Cypher stent (DP-SES) in women undergoing percutaneous coronary intervention (PCI).MethodsA total of 455 female patients with stable CAD were randomly assigned to receive DP-EES (n = 304) or DP-SES (n = 151). The powered angiographic outcome of the trial was in-stent late lumen loss (LLL) at 9 months after the index procedure. Secondary angiographic end points included in-segment LLL, in-stent and in-segment binary restenosis and percent diameter stenosis. The primary clinical outcome was a composite of all-cause death, myocardial infarction (MI) or target vessel revascularization (TVR).ResultsAt 9-month follow-up, in-stent LLL was 0.19±0.38 mm and 0.11±0.37 mm in patients assigned to DP-EES and DP-SES, respectively. The one-sided upper 95% CI of the difference in in-stent LLL between the groups of 0.08 mm was 0.15 and therefore within the pre-specified non-inferiority margin of 0.17 mm (p for non-inferiority = 0.013). However, the test for superiority showed a borderline significant difference in terms of LLL between DP-EES and DP-SES (p for superiority = 0.044). There were no significant differences in binary restenosis (2.0% vs. 0.72%, p = 0.44) and percent diameter stenosis (14.97±12.17 vs. 13.36±10.82, p = 0.19). The rate of definite stent thrombosis at 12 months was lower in patients treated with DP-EES (0% vs. 2.0%, p = 0.036).ConclusionsAmong women undergoing PCI, DP-EES was associated with a small but probably clinically relevant increase in in-stent LLL at 9 months as compared to DP-SES and with a lower risk of definite stent thrombosis at 12 months.Trial registrationClinicalTrials.gov NCT01182428.https://clinicaltrials.gov/

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“…Several studies have focused only on gender [ 17 , 18 ]; therefore, we investigated the relationship between coronary vessel sizes and age, DM, LVEF, renal dysfunction, and the clinical presentation of myocardial ischemia. Before coronary intervention, interventional cardiologists have several preconceptions regarding elderly patients [ 20 ] and/or patients with DM that they have considerably smaller coronary vessels than other patients. Our findings were consistent with those observed in our practical experience.…”

Section: Discussionmentioning

confidence: 99%

Urban Legend or Real Fact: Coronary artery size varies with demographics

Tatlısu

Sarğın

Kaya

et al. 2017

North Clin Istanbul

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OBJECTIVE:This study aimed to determine the relationship between the diameter of coronary artery stents and age, gender, diabetes mellitus (DM), left ventricular ejection fraction (LVEF), renal dysfunction, and the clinical presentation of myocardial ischemia in the cohort of patients with implanted stents in coronary arteries with severe stenotic lesions.METHODS:This study included 2256 patients (mean age, 59.3±10.9 years; men, 62%) who underwent percutaneous coronary intervention (PCI). The clinical status of the patients at presentation was subcategorized as follows: ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, unstable angina pectoris, and stable angina pectoris. The diameters, without any type or brand differentiation, were divided into two groups as follows: Group I, which included 2.5- and 2.75-mm-diameter stents, and Group II, which included ≥3-mm-diameter stents.RESULTS:The type of procedure, including primary PCI, early invasive strategy, and elective stenting, was not found to be a significant factor affecting the diameter of coronary artery stents. Univariate and multivariate analyses revealed a relationship between the diameter of coronary artery stents and age, gender, DM, and LVEF.CONCLUSION:This study demonstrated that the diameter of coronary artery stents was independently associated with gender, age, a history of DM, and moderate-to-severe systolic left ventricular dysfunction.

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Gender based differences in drug eluting stent implantation - data from the German ALKK registry suggest underuse of DES in elderly women

Cited by 16 publications

References 33 publications

Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

A randomized multicenter trial comparing the XIENCE everolimus eluting stent with the CYPHER sirolimus eluting stent in the treatment of female patients with de novo coronary artery lesions: The SPIRIT WOMEN study

Urban Legend or Real Fact: Coronary artery size varies with demographics

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