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Giustino, Gennaro, MD; Baber, Usman, MD, MSc; Stefanini, Giulio Giuseppe, MD; Aquino, Melissa, MSc; Stone, Gregg W., MD; Sartori, Samantha, PhD; Steg, Philippe Gabriel, MD; Wijns, William, MD, PhD; Smits, Pieter C., MD, PhD; Jeger, Raban V., MD; Leon, Martin B., MD; Windecker, Stephan, MD, PhD; Serruys, Patrick W., MD, PhD; Morice, Marie-Claude, MD; Camenzind, Edoardo, MD; Weisz, Giora, MD; Kandzari, David, MD; Dangas, George D., MD, PhD; Mastoris, Ioannis, MD; Von Birgelen, Clemens, MD, PhD; Galatius, Soren, MD, PhD; Kimura, Takeshi, MD, PhD; Mikhail, Ghada, MD; Itchhaporia, Dipti, MD; Mehta, Laxmi, MD; Ortega, Rebecca, MD; Kim, Hyo-Soo, MD, PhD; Valgimigli, Marco, MD, PhD; Kastrati, Adnan, MD; Chieffo, Alaide, MD; Mehran, Roxana, MD
The American journal of cardiology, 09/2015, Letnik: 116, Številka: 6Journal Article
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.
