Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes.
Women are frequently reported to have increased morbidity after presentation with acute coronary syndromes and myocardial infarction; however, whether a greater thrombotic tendency contributes to gender differences in clinical outcomes of urgent percutaneous coronary intervention is unknown. Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials. We compared major adverse cardiac events (MACE) at in-hospital, 30-day, and 1-year follow-up and major bleeding at 30 days according to gender and the presence or absence of IPTE. IPTE was identified in 507 patients (7.7%), with 119 of 1,744 (6.8%) occurring in women and 388 of 4,847 (8.0%) in men (p = 0.12). IPTE, but not gender, was independently associated with MACE at in-hospital and 30-day follow-up. At 1-year follow-up, the adjusted hazard of MACE was higher in women and in patients with IPTE; however, the risk of MACE associated with IPTE was similar among women and men. There was no significant interaction between IPTE and gender for 1-year MACE or 30-day bleeding. IPTE predicted major bleeding only in women. In conclusion, in acute coronary syndromes, women have increased risk of adverse outcome at 1 year. IPTEs are common, occur at similar frequency, and are associated with similar degree of increased MACE in both genders at short- and long-term follow-up. Higher thrombotic propensity does not offer a mechanistic explanation for the worse outcomes noted in women.
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Mikkel M
MM
Schoos
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Roxana
R
Mehran
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
George D
GD
Dangas
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Prince of Wales Clinical School, Randwick, New South Wales, Australia.
Jennifer
J
Yu
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Usman
U
Baber
Department of Cardiology, Nykobing F Hospital, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Peter
P
Clemmensen
New York University Langone Medical Center, New York, New York.
Frederick
F
Feit
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Bernard J
BJ
Gersh
Department of Interventional Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Giulio
G
Guagliumi
Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
E Magnus
EM
Ohman
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Stuart J
SJ
Pocock
Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany.
Bernhard
B
Witzenbichler
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, Columbia University Medical Center, New York, New York.
Gregg W
GW
Stone
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic; D000077144:Clopidogrel; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D017239:Paclitaxel / Q000494:pharmacology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D000972:Antineoplastic Agents, Phytogenic; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D017239:Paclitaxel