title: Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study.
abstract: BACKGROUND
  Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under-treatment. We sought to compare the 1-year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort.
  
  
  METHODS
  PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression.
  
  
  RESULTS
  The study cohort included 4,851 patients of which 1,162 (24.0%) were women and 3,689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one-third of patients (31.8% in men vs. 28.1% in women, P = 0.01). Unadjusted, 1-year MACE (21.1% vs. 16.2%, P < 0.001) and bleeding (3.6% vs. 2.2%, P = 0.01) was significantly higher in women compared with men, but these results were no longer significant after adjustment for risk (HR 1.13, 95% CI 0.94-1.36 for MACE and HR 1.31, 95% CI 0.85-2.04 for bleeding).
  
  
  CONCLUSIONS
  Women ≤ 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1-year MACE and bleeding than male sex, findings that are attributable to baseline differences. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jaya
authors.initials: J
authors.lastname: Chandrasekhar
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Michela
authors.initials: M
authors.lastname: Faggioni
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Melissa
authors.initials: M
authors.lastname: Aquino
authors.affiliation: Mount Sinai Hospital, New York, New York.
authors.forename: Annapoorna
authors.initials: A
authors.lastname: Kini
authors.affiliation: Christiana Care Health System, Newark, Delaware.
authors.forename: William
authors.initials: W
authors.lastname: Weintraub
authors.affiliation: Division of Cardiology, Duke University, Durham, North Carolina.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rao
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.affiliation: Christiana Care Health System, Newark, Delaware.
authors.forename: Sandra
authors.initials: S
authors.lastname: Weiss
authors.affiliation: Division of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Craig
authors.initials: C
authors.lastname: Strauss
authors.affiliation: Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.affiliation: Division of Cardiology, Intermountain Heart Institute, Salt-Lake City, Utah.
authors.forename: Brent
authors.initials: B
authors.lastname: Muhlestein
authors.affiliation: Aurora Cardiovascular Services, Milwaukee, Wisconsin.
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFranco
authors.affiliation: John Ochsner Heart and Vascular Center, Ochsner Medical Center, New Orleans, Louisiana.|Eli Lilly and Company, Indianapolis, Indiana.
authors.forename: Mark
authors.initials: M
authors.lastname: Effron
authors.affiliation: Eli Lilly and Company, Indianapolis, Indiana.
authors.forename: Stuart
authors.initials: S
authors.lastname: Keller
authors.affiliation: Daiichi-Sankyo, Inc., Parsippany, New Jersey.
authors.forename: Brian
authors.initials: B
authors.lastname: Baker
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Timothy
authors.initials: T
authors.lastname: Henry
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000601:surgery*; D000367:Age Factors; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: long-term outcomes; percutaneous coronary intervention; sex-related differences; under-treatment in women; young patients with acute coronary syndrome