title: Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study trial.
abstract: OBJECTIVE
  We assessed the relation between female sex and sirolimus-eluting stent (SES) use on long-term outcomes in acute myocardial infarction.
  
  
  BACKGROUND
  There are no data on sex-specific differences in long-term benefit of SES use compared with bare-metal stent (BMS) use among patients undergoing primary percutaneous coronary interventions.
  
  
  METHODS
  We performed a post hoc analysis of the MULTISTRATEGY trial. Hazard ratios (HRs) of events with 95% CI for sex and stent type were computed using Cox proportional regression with adjustment for confounders.
  
  
  RESULTS
  A total of 744 patients, 64 years old (55-73 years old), 179 (24.1%) women, were enrolled. After a follow-up of 1,080 days, SES use was associated with a significant reduction of major adverse cardiovascular events, that is, the composite of all-cause death, reinfarction, or clinically driven target vessel revascularization (TVR) (13.9% vs 23.6%, adjusted HR 0.62, 95% CI 0.41-0.94, P = .026) and of TVR (6.1% vs 15.1%, adjusted HR 0.35, 95% CI 0.19-0.63, P < .001) in men. Conversely, SES use was not associated to a better outcome among women (major adverse cardiovascular events 21.9% in SES vs 18.2% in the BMS group, adjusted HR 1.27, 95% CI 0.53-3.02, P = .59; TVR 6.6% vs 9.1%, adjusted HR 0.62, 95% CI 0.17-2.21, P = .46).
  
  
  CONCLUSIONS
  In this analysis, the clinical benefit of SES use, over BMS, at 3-year follow-up was restricted to men and was not observed among women.
authors.affiliation: Department of Interventional Cardiology, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.forename: Elena
authors.initials: E
authors.lastname: Corrada
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Colangelo
authors.forename: Nicoletta
authors.initials: N
authors.lastname: De Cesare
authors.forename: Alfredo
authors.initials: A
authors.lastname: E Rodriguez
authors.forename: Ezio
authors.initials: E
authors.lastname: Bramucci
authors.forename: Raul
authors.initials: R
authors.lastname: Moreno
authors.forename: Tommaso
authors.initials: T
authors.lastname: Piva
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Pasquetto
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Marco S
authors.initials: MS
authors.lastname: Nazzaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D001145:Arrhythmias, Cardiac / Q000150:complications; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012008:Recurrence; D012737:Sex Factors; D020123:Sirolimus / Q000008:administration & dosage*; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban; D020123:Sirolimus; D000077284:Abciximab