title: Sex-related Impact on Clinical Outcome of Everolimus-eluting Versus Bare-metal Stents in ST-segment Myocardial Infarction. Insights From the EXAMINATION Trial.
abstract: OBJECTIVE
  The use of second-generation drug-eluting stents compared with bare-metal stents in patients with ST-segment elevation myocardial infarction reduces the rate of major adverse cardiac events. We aimed to evaluate the impact of sex on the performance of everolimus-eluting stents vs bare-metal stents in ST-segment elevation myocardial infarction at 2-year follow-up.
  
  
  METHODS
  This is a sub-study of the EXAMINATION trial that randomized 1498 patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention to everolimus-eluting or bare-metal stents. Primary end point was combined all-cause death, any recurrent myocardial infarction, and any revascularization. All end points were analyzed according to sex at 2-year follow-up.
  
  
  RESULTS
  Of 1498 patients included in the trial, 254 (17.0%) were women. Women were older and had higher prevalence of hypertension and lower prevalence of smoking compared with men. In contrast with men, stent diameter was smaller in women. After multivariate analysis, the primary end point was similar between women and men (hazard ratio=0.95; 95% confidence interval, 0.66-1.37), and among women, between those treated with bare-metal vs everolimus-eluting stents (hazard ratio=2.48; 95% confidence interval, 0.95-6.46). Women showed a lower rate of repeat revascularization than men (hazard ratio=0.55; 95% confidence interval, 0.32-0.95) despite worse baseline characteristics. This difference was driven by better performance of the everolimus-eluting stent in women.
  
  
  CONCLUSIONS
  Despite poorer baseline clinical characteristics, women with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention showed outcomes similar to men. The use of everolimus-eluting stents may represent an added value in women as it showed a reduced rate of repeated revascularization compared to men.
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Fernández-Rodríguez
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín-Yuste
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Masotti
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cequier
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Íñiguez
authors.affiliation: Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain. Electronic address: masabate@clinic.ub.es.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012737:Sex Factors; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
keywords: Infarto de miocardio; Myocardial infarction; Sex; Sexo; Stent