title: Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents.
abstract: The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Giulio Giuseppe
authors.initials: GG
authors.lastname: Stefanini
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Melissa
authors.initials: M
authors.lastname: Aquino
authors.affiliation: Columbia University Medical Center, New York City, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.affiliation: Département Hospitalo Universitaire Fibrose, Inflammation et REmodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U-1148, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.affiliation: Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.affiliation: University Hospital Basel, Basel, Switzerland.
authors.forename: Raban V
authors.initials: RV
authors.lastname: Jeger
authors.affiliation: Columbia University Medical Center, New York City, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: ErasmusMC, Rotterdam, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: University of Geneva, Geneva, Switzerland.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Camenzind
authors.affiliation: Columbia University Medical Center, New York City, New York; Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Kandzari
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mastoris
authors.affiliation: Thoraxcentrum Twente, Enschede, The Netherlands.
authors.forename: Clemens
authors.initials: C
authors.lastname: Von Birgelen
authors.affiliation: Gentofte University Hospital, Hellerup, Denmark.
authors.forename: Soren
authors.initials: S
authors.lastname: Galatius
authors.affiliation: Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Ghada
authors.initials: G
authors.lastname: Mikhail
authors.affiliation: Hoag Memorial Hospital Presbyterian, Newport Beach, California.
authors.forename: Dipti
authors.initials: D
authors.lastname: Itchhaporia
authors.affiliation: Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Laxmi
authors.initials: L
authors.lastname: Mehta
authors.affiliation: Society of Cardiovascular Angiography and Interventions, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ortega
authors.affiliation: Seoul National University Main Hospital, Seoul, Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: University of Ferrara, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Herzzentrum, Munich, Germany.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York. Electronic address: Roxana.Mehran@mountsinai.org.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000209:etiology / Q000601:surgery*; D000789:Angina, Unstable / Q000209:etiology / Q000601:surgery*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D016896:Treatment Outcome