title: Mechanisms of atherothrombosis and vascular response to primary percutaneous coronary intervention in women versus men with acute myocardial infarction: results of the OCTAVIA study.
abstract: OBJECTIVE
  This study sought to assess in vivo sex differences in the pathophysiology of ST-segment elevation myocardial infarction (STEMI) and vascular response to primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  There is no consensus on whether differences in the pathophysiology of STEMI and response to primary PCI between women and men reflect biological factors as opposed to differences in age.
  
  
  METHODS
  In this prospective, multicenter study, 140 age-matched men and women with STEMI undergoing primary PCI with everolimus-eluting stent were investigated with intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers. Primary endpoints were the percentages of culprit plaque rupture at baseline and everolimus-eluting stent strut coverage at 9-month follow-up as determined by optical coherence tomography.
  
  
  RESULTS
  Men and women had similar rates of plaque rupture (50.0% vs. 48.4%; risk ratio [RR]: 1.03; 95% confidence interval [CI]: 0.73 to 1.47; p = 0.56). Nonruptured/eroded plaques comprised 25% of all cases (p = 0.86 in men vs. women). There were no sex differences in composition of aspirated thrombus and immune and inflammatory serum biomarkers. At 9 months, women had similar strut coverage (90.9% vs. 92.5%; difference in medians: RR: 0.2%; 95% CI: -0.4% to 1.3%; p = 0.89) and amount of in-stent neointimal obstruction (10.3% vs. 10.6%; p = 0.76) as men did. There were no sex differences in clinical outcome either at 30-day or 1-year follow-up.
  
  
  CONCLUSIONS
  In patients presenting with STEMI undergoing primary PCI, no differences in culprit plaque morphology and factors associated with coronary thrombosis were observed between age-matched men and women. Women also showed similar vascular healing response to everolimus-eluting stents as men did. (Optical Coherence Tomography Assessment of Gender Diversity In Primary Angioplasty: The OCTAVIA Trial [OCTAVIA]; NCT01377207).
authors.affiliation: Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. Electronic address: guagliumig@gmail.com.
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.affiliation: Cardiovascular Department, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Cardiovascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Cardiovascular Department, University of Padova Medical School, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Cardiovascular Department, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Garbo
authors.affiliation: Cardiovascular Department, Ospedale Civile di Asti, Asti, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Tumminello
authors.affiliation: Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Vasile
authors.initials: V
authors.lastname: Sirbu
authors.affiliation: Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Micol
authors.initials: M
authors.lastname: Coccato
authors.affiliation: Cardiovascular Department, Policlinico S. Maria alle Scotte, Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Fineschi
authors.affiliation: Catholic University of the Sacred Heart, Roma, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.affiliation: Cardiovascular Department, Ospedale Mauriziano, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: De Benedictis
authors.affiliation: Cardiovascular Department, Azienda Ospedaliera Grosseto, Grosseto, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.affiliation: Division of Cardiology, European Hospital-Aurelia Hospital, Roma, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Cardiovascular Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Cardiovascular Imaging Department, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Hiram
authors.initials: H
authors.lastname: Bezerra
authors.affiliation: CV Path Institute, Gaithersburg, Maryland.
authors.forename: Elena
authors.initials: E
authors.lastname: Ladich
authors.affiliation: Cardiovascular Imaging Department, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.affiliation: CV Path Institute, Gaithersburg, Maryland.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D058426:Neointima; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012737:Sex Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: etiology; myocardial infarction; myocardial revascularization; sex differences