Gender-based outcomes after paclitaxel-eluting stent implantation in patients with coronary artery disease.
OBJECTIVE
We sought to determine whether gender influences the results of paclitaxel-eluting stent implantation.


BACKGROUND
The TAXUS-IV trial demonstrated the safety and effectiveness of the slow-release, polymer-based, paclitaxel-eluting TAXUS stent compared to bare-metal stents in patients undergoing elective coronary intervention. Whether these results are generalizable to women is not known.


METHODS
A total of 1,314 patients with coronary lesions 10- to 28-mm long in 2.5- to 3.75-mm vessels were randomized to TAXUS stent versus bare-metal EXPRESS stents (Boston Scientific Corp., Natick, Massachusetts). Outcomes examined were stratified by gender.


RESULTS
A total of 662 patients (including 187 women) were assigned to the TAXUS stent, and 652 (180 women) received the control stent. Women were older than men, and had more hypertension, diabetes, renal insufficiency, unstable angina, and heart failure, but less smoking. Among patients receiving the TAXUS stent, women compared with men had higher unadjusted one-year rates of target lesion revascularization (TLR) (7.6% vs. 3.2%, p = 0.03), though female gender was not an independent predictor of TLR (odds ratio [OR] = 1.72 [95% confidence interval (CI) 0.68 to 4.37], p = 0.25). Moreover, restenosis rates were similar in men and women treated with the TAXUS stent (8.6% vs. 7.6%, respectively, p = 0.80), as was late loss (0.22 vs. 0.23 mm, p = 0.90). Compared to control stents, treatment with the TAXUS stent in women resulted in a significant reduction in nine-month restenosis (8.6% vs. 29.2%, p = 0.0001) and one-year TLR (7.6% vs. 14.9%, p = 0.02). The only independent predictor of freedom from restenosis in women was randomization to the TAXUS stent (OR = 0.28 [95% CI 0.11 to 0.74], p = 0.01).


CONCLUSIONS
The benefits of the paclitaxel-eluting stent in reducing clinical and angiographic restenosis are generalizable to women.
Lansky
Alexandra J
AJ
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
Costa
Ricardo A
RA
Mooney
Michael
M
Midei
Mark G
MG
Lui
Henry K
HK
Strickland
Warren
W
Mehran
Roxana
R
Leon
Martin B
MB
Russell
Mary E
ME
Ellis
Stephen G
SG
Stone
Gregg W
GW
D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D017239:Paclitaxel / Q000008:administration & dosage*; D011108:Polymers; D012737:Sex Factors; D015607:Stents; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D011108:Polymers; D017239:Paclitaxel