Sex‐Based Differences in Bleeding Risk After Percutaneous Coronary Intervention and Implications for the Academic Research Consortium High Bleeding Risk Criteria

Spirito, Alessandro; Gragnano, Felice; Corpataux, Noé; Vaisnora, Lukas; Galea, Roberto; Svab, Stefano; Gargiulo, Giuseppe; Siontis, George C.M.; Praz, Fabien; Lanz, Jonas; Billinger, Michael; Hunziker, Lukas; Stortecky, Stefan; Pilgrim, Thomas; Capodanno, Davide; Urban, Philip; Pocock, Stuart J.; Mehran, Roxana; Heg, Dik; Windecker, Stephan; Räber, Lorenz; Valgimigli, Marco

doi:10.1161/jaha.121.021965

Cited by 26 publications

(24 citation statements)

References 28 publications

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“…On the same issue, also personality traits and social roles traditionally ascribed to women could help explaining longer diagnosis and treatment delays in women [ 22 ]. Finally, women present also procedural technical aspects (such as an higher rate of radial artery spasm) that could leads to an increased risk of complications (access site bleeding and contrast induced nephropathy) and receive less frequently guideline-suggested treatments in comparison with men [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome

Bianchi

Maloberti

Peretti

et al. 2021

High Blood Press Cardiovasc Prev

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Introduction Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS). Aim Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test-6-MWT) and functional improvement in patients undergoing CR after an ACS. Methods The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. Δ meters were used to represent functional improvement. Results Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, Δ meters and % Δ meters. Standardized regression coefficients showed that age (β = − 0.237; p < 0.001), BMI (β = − 0.116; p = 0.006) and heart rate (β = − 0.082; p = 0.040) were determinants of exercise capacity (6MWT-1 and 2), whereas age (β = −.231; p = 0.004), sex (β = − 0.187; p = 0.008) and BMI (β = − 0.164; p = 0.022) were determinants of functional improvement (Δ meters). Conclusions Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex).

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Section: Discussionmentioning

confidence: 99%

Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome

Bianchi

Maloberti

Peretti

et al. 2021

High Blood Press Cardiovasc Prev

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“…Recently, the ARC-HBR criteria were established to standardize the definition of HBR and promote consistency across trials evaluating this vulnerable subset of patients [ 31 ]. A number of studies have reported on the predictive value of the ARC-HBR definition in identifying patients at increased risk not only for bleeding but also for thrombotic events [ 18 , 32 – 34 ], as well as validated the clinical usefulness of the ARC-HBR criteria in relation to clinical presentation and sex [ 35 , 36 ]. Given that bleeding risk was a major reason for discontinuation of DAPT, we also assessed the effects of DAPT interruption ≤12 months compared with DAPT maintenance >12 months in a contemporary PCI population at high ischemic risk and HBR ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

Thrombotic vs. Bleeding Events of Interruption of Dual Antiplatelet Therapy within 12 Months among Patients with Stent-Driven High Ischemic Risk Definition following PCI

Wang

Song

et al. 2022

Journal of Interventional Cardiology

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Background. There is a paucity of real-world data regarding the clinical impact of dual antiplatelet therapy (DAPT) interruption (temporary or permanent) among patients at high ischemic risk. The aim of this study was to assess the risk of cardiovascular events after interruption of DAPT in high-risk PCI population. Methods. This study used data from the Fuwai PCI registry, a large, prospective cohort of consecutive patients who underwent PCI. We assessed 3,931 patients with at least 1 high ischemic risk criteria of stent-related recurrent ischemic events proposed in the 2017 ESC guidelines for focused update on DAPT who were free of major cardiac events in the first 12 months. The primary ischemic endpoint was 30-month major adverse cardiac and cerebrovascular events, and the key safety endpoints were BARC class 2, 3, or 5 bleeding and net adverse clinical events. Results. DAPT interruption within 12 months occurred in 1,122 patients (28.5%), most of which were due to bleeding events or patients’ noncompliance to treatment. A multivariate Cox regression model, propensity score (PS) matching, and inverse probability of treatment weighting (IPTW) based on the propensity score demonstrated that DAPT interruption significantly increased the risk of primary ischemic endpoint compared with prolonged DAPT (3.9% vs. 2.2%; Cox-adjusted hazard ratio (HR): 1.840; 95% confidence interval (CI): 1.247 to 2.716; PS matching-HR: 2.049 [1.236–3.399]; IPTW-adjusted HR: 1.843 [1.250–2.717]). This difference was driven mainly by all-cause death (1.8% vs. 0.7%) and MI (1.3% vs. 0.5%). Furthermore, the rate of net adverse clinical events (4.9% vs. 3.2%; Cox-adjusted HR: 1.581 [1.128–2.216]; PS matching-HR: 1.639 [1.075–2.499]; IPTW-adjusted HR: 1.554 [1.110–2.177]) was also higher in patients with DAPT interruption (≤12 months), whereas no significant differences between groups were observed in terms of BARC 2, 3, or 5 bleeding. These findings were consistent across various stent-driven high-ischemic risk subsets with respect to the primary ischemic endpoints, with a greater magnitude of harm among patients with diffuse multivessel diabetic coronary artery disease. Conclusions. In patients undergoing high-risk PCI, interruption of DAPT in the first 12 months occurred infrequently and was associated with a significantly higher adjusted risk of major adverse cardiovascular events and net adverse clinical events. 2017 ESC stent-driven high ischemic risk criteria may help clinicians to discriminate patient selection in the use of long-term DAPT when the ischemic risk certainly overcomes the bleeding one.

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“…Another reason is that women are less likely to receive acute reperfusion therapy [ 148 , 149 ] and optimal medical therapy (OMT) [ 148 ]. Finally, the female gender represents an independent risk factor for peri-procedural AMI and major bleedings after percutaneous coronary intervention, which is notably associated with increased mortality [ 58 , 150 ].…”

Section: Gender Differences In Cardiovascular Diseases: From Epidemio...mentioning

confidence: 99%

“…The diagnosis of MINOCA should be made following the Fourth Universal Definition of myocardial infarction (MI), requiring an AMI in the absence of obstructive CAD (no lesion ≥50%) [ 152 ]. MINOCA occurs in 5–6% of AMI [ 150 ]. A differential diagnosis from other cardiac and noncardiac disorders is essential [ 167 ].…”

Section: Gender Differences In Cardiovascular Diseases: From Epidemio...mentioning

confidence: 99%

Update on Management of Cardiovascular Diseases in Women

Lucà¹,

Abrignani

Parrini

et al. 2022

JCM

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Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.

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Sex‐Based Differences in Bleeding Risk After Percutaneous Coronary Intervention and Implications for the Academic Research Consortium High Bleeding Risk Criteria

Cited by 26 publications

References 28 publications

Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome

Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome

Thrombotic vs. Bleeding Events of Interruption of Dual Antiplatelet Therapy within 12 Months among Patients with Stent-Driven High Ischemic Risk Definition following PCI

Update on Management of Cardiovascular Diseases in Women

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