Association of Sex With Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Chichareon, Ply; Modolo, Rodrigo; Kerkmeijer, Laura S.M.; Tomaniak, Mariusz; Kogame, Norihiro; Takahashi, Kuniaki; Chang, Chun-Chin; Komiyama, Hidenori; Moccetti, Tiziano; Talwar, Suneel; Colombo, Antonio; Maillard, Luc; Barlis, Peter; Wykrzykowska, Joanna J.; Piek, Jan J.; Garg, Scot; Hamm, Christian W.; Steg, Philippe Gabríel; Jüni, Peter; Valgimigli, Marco; Windecker, Stephan; Onuma, Yoshinobu; Mehran, Roxana; Serruys, Patrick W.

doi:10.1001/jamacardio.2019.4296

Cited by 56 publications

(62 citation statements)

References 33 publications

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“…Congruent with recent studies of newer P2Y12 inhibitors 28,29) , this study showed an increased risk of bleeding in women compared with men. However, there was no significant difference between ticagrelor and prasugrel in women or men and no treatment arm-by-sex interaction with respect to the risk of bleeding with these drugs in both sexes.…”

Section: Discussionmentioning

confidence: 50%

Efficacy and Safety of Ticagrelor Versus Prasugrel in Women and Men with Acute Coronary Syndrome: A Pre-specified, Sex-Specific Analysis of the ISAR-REACT 5 Trial

Gewalt

Lahu

Ndrepepa

et al. 2022

JAT

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Sex-specific analyses of direct head-to-head comparisons between newer P2Y12 inhibitors are limited. This study was conducted to assess the efficacy and safety of ticagrelor versus prasugrel in women and men with acute coronary syndromes (ACS) planned for an invasive strategy.Methods: This pre-specified analysis of the ISAR-REACT 5 trial included 956 women and 3,062 men with ACS randomly assigned to either ticagrelor or prasugrel. The primary endpoint was the 12-month incidence of death, myocardial infarction, or stroke; the safety endpoint was the 12-month incidence of bleeding (type 3-5 according to the Bleeding Academic Research Consortium [BARC]). Results: The primary endpoint occurred in 42 women (8.9%) in the ticagrelor group and 39 women (8.3%) in the prasugrel group (hazard ratio [HR] 1.10, 95% confidence interval [CI] 0.71-1.70, P 0.657) and in 142 men (9.4%) in the ticagrelor group and 98 men (6.5%) in the prasugrel group (HR 1.47 [1.13-1.90], P 0.004; P for interaction [Pint] 0.275). BARC type 3-5 bleeding occurred in 36 women (9.7%) in the ticagrelor group and 34 women (9.7%) in the prasugrel group (HR 1.04 [0.65-1.67], P 0.856) and in 59 men in the ticagrelor group (4.4%) and 46 men (3.6%) in the prasugrel group (HR 1.24 [0.85-1.83], P 0.266; Pint 0.571). Conclusions:Although there was no significant interaction between sex and treatment effect of study drugs, the superior efficacy of prasugrel was more evident among men. No difference in bleeding between the two study groups was seen for both women and men.approximately 41% of patients discharged with the diagnosis of an acute coronary syndrome (ACS) are female 1) . Women presenting with an ACS are older

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Section: Discussionmentioning

confidence: 50%

Efficacy and Safety of Ticagrelor Versus Prasugrel in Women and Men with Acute Coronary Syndrome: A Pre-specified, Sex-Specific Analysis of the ISAR-REACT 5 Trial

Gewalt

Lahu

Ndrepepa

et al. 2022

JAT

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“…Similar to our registry, main independent predictors for cardiovascular mortality or non-fatal myocardial infarction were age, diabetes, smoking, prior MI, peripheral artery disease, but also prior stroke, atrial fibrillation, and history of hospitalization for heart failure. A pooled analysis of individual patient data regarding outcome after PCI [ 37 ], a subgroup analysis of the GLOBAL LEADERS trial [ 38 ], and a sex-related study on patients with acute myocardial infarction [ 39 ] also found no association of sex with long-term mortality. In contrast, 10 years ago Ezekowitz et al [ 17 ] reported on a higher 1-year mortality in women with CAD compared to men, but prescription rates for guideline-recommended medication were lower in that study than in our registry.…”

Section: Discussionmentioning

confidence: 99%

“…A pooled analysis of individual patient data regarding outcome after PCI [37], a subgroup analysis of the GLOBAL LEADERS trial [38], and a sex-related study on patients with acute myocardial infarction [39] also found no association of sex with long-term mortality. In contrast, 10 years ago Ezekowitz et al [17] reported on a higher 1-year mortality in women with CAD compared to men, but prescription rates for guideline-recommended medication were lower in that study than in our registry.…”

Section: Outcome and Mortalitymentioning

confidence: 99%

Sex-specific differences and long-term outcome of patients with coronary artery disease and chronic kidney disease: the Coronary Artery Disease and Renal Failure (CAD-REF) Registry

et al. 2021

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Background Cardiovascular morbidity and mortality are closely linked to chronic kidney disease (CKD). Sex-specific long-term outcome data of patients with coronary artery disease (CAD) and CKD are scarce. Methods In the prospective observational multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry, 773 (23.1%) women and 2,579 (76.9%) men with angiographically documented CAD and different stages of CKD were consecutively enrolled and followed for up to 8 years. Long-term outcome was evaluated using survival analysis and multivariable Cox-regression models. Results At enrollment, women were significantly older than men, and suffered from more comorbidities like CKD, hypertension, diabetes mellitus, and multivessel coronary disease. Regarding long-term mortality, no sex-specific differences were observed (Kaplan–Meier survival estimates: 69% in women vs. 69% in men, plog-rank = 0.7). Survival rates decreased from 89% for patients without CKD at enrollment to 72% for patients with CKD stages 1–2 at enrollment and 49% for patients with CKD stages 3–5 at enrollment (plog-rank < 0.001). Cox-regression analysis revealed that sex or multivessel coronary disease were no independent predictors of long-term mortality, while age, CKD stages 3–5, albumin/creatinine ratio, diabetes, valvular heart disease, peripheral artery disease, and left-ventricular ejection fraction were predictors of long-term mortality. Conclusions Sex differences in CAD patients mainly exist in the cardiovascular risk profile and the extent of CAD. Long-term mortality was not depended on sex or multivessel disease. More attention should be given to treatment of comorbidities such as CKD and peripheral artery disease being independent predictors of death. Clinical Trail Registration ClinicalTrials.gov Identifier: NCT00679419 Graphic abstract

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“…Существуют гендерные различия в оценке прогноза заболевания после перенесенного ЧКВ. В ряде работ продемонстрирован более высокий риск осложнений ЧКВ у женщин по сравнению с мужчинами [14,15]. По результатам нашего исследования у женщин вдвое чаще встречались превышения ВГН Вч-Тр (40% против 70%, p=0,048), также чаще развивался ИМ 4а типа (21% против 3%, p<0,05).…”

Section: Discussionunclassified

The Effect of Pharmacological Preconditioning with Nicorandil before Elective Coronary Stenting on the Long-Term Prognosis of Patients with Stable Coronary Artery Disease

Соболева

Gostishchev²,

Рогоза

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To study nicorandil prescription effects before elective percutaneous coronary intervention (PCI) to prevent myocardial injury and 4a type acute myocardial infarction (MI, primary endpoint) and cardiovascular events (CVE) in the first year after PCI (secondary endpoint) in patients with stable coronary artery disease.Material and methods. 182 patients with stable coronary artery disease were included into the study and were randomized into two groups: nicorandil treatment group (n=90) and a control group with a standard medical treatment (n=92). Nicorandil was prescribed orally: 2 days before PCI – 30 mg/day; on the day of PCI – 20 mg 2 hours before intervention and 10 mg 6-12 hours after PCI; over the next 30 days – 30 mg/day. High sensitivity troponin I (hs-Tr) and creatine kinase-MB tests were carried out before PCI, 24 and 72 hours after the intervention; the 4a type MI was diagnosed according to the 4th Universal Definition. Non-fatal myocardial infarction, nonfatal stroke, death from cardiovascular diseases, repeat revascularization (PCI, coronary artery bypass surgery due to aggravation), hospital admissions for angina pectoris recurrence (without interventions) and death from any causes were considered as cardiovascular events. Data on adverse outcomes were collected over the hospital stay, and then 30, 180 and 365 days after the hospital discharge.Results. 4a type MI was diagnosed in 14 patients (8%), in women – 12% and in men – 6%. There was a significant decrease in the incidence of type 4a MI in the nicorandil group (n=3; 3%) compared with the control group (n=11; 12%; p=0.05). Secondary endpoint was recorded in 21% of patients. The relationship was found between 4a type MI and the incidence of CVE the next year after the PCI (p=0.01). In patients with type 4a MI CVE odd ratio increases 5.8 times with confidence interval from 1.5426 to 21.6024. According to the logistic regression analysis the significant relationship between hs-Tr growth 24 hours after the PCI and CVE incidence next year after the PCI was found with cutting value 389.8 pg/ml, AUC=0.641 (p=0.04).Сonclusion. Peroral nicorandil 30 mg/day 2 days before PCI, 20 mg 2 hours before surgery and 10 mg 6-12 hours after PCI, and 30 mg/day next 30 days after PCI decreases the risk of intraoperative myocardial injury and CVE in the next year after PCI.

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Association of Sex With Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Cited by 56 publications

References 33 publications

Efficacy and Safety of Ticagrelor Versus Prasugrel in Women and Men with Acute Coronary Syndrome: A Pre-specified, Sex-Specific Analysis of the ISAR-REACT 5 Trial

Efficacy and Safety of Ticagrelor Versus Prasugrel in Women and Men with Acute Coronary Syndrome: A Pre-specified, Sex-Specific Analysis of the ISAR-REACT 5 Trial

Sex-specific differences and long-term outcome of patients with coronary artery disease and chronic kidney disease: the Coronary Artery Disease and Renal Failure (CAD-REF) Registry

The Effect of Pharmacological Preconditioning with Nicorandil before Elective Coronary Stenting on the Long-Term Prognosis of Patients with Stable Coronary Artery Disease

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