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Published online: 2021-01-20
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Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

Eun-Seok Shin, Eun Jung Jun, Jung-Kyu Han, Min Gyu Kong, Jeehoon Kang, Chengbin Zheng, Scot Garg, Young Jin Choi, Jang-Whan Bae, Kook-Jin Chun, Doo-Il Kim, Seung-Woon Rha, Sung Yun Lee, Jay Young Rhew, Seong-Ill Woo, Han Cheol Lee, Jin-Ok Jeong, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, In-Ho Chae, Hyo-Soo Kim
DOI: 10.5603/CJ.a2021.0008
·
Pubmed: 33634845

open access

Ahead of print
Original articles
Published online: 2021-01-20

Abstract

Background: The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.

Methods: Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097–1140 days), and the primary endpoint was cardiac death at 3 years.

Results: The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and STEMI in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53–0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65–1.44, p = 0.884).

Conclusions: There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.

Abstract

Background: The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.

Methods: Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097–1140 days), and the primary endpoint was cardiac death at 3 years.

Results: The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and STEMI in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53–0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65–1.44, p = 0.884).

Conclusions: There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.

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Keywords

coronary artery disease, percutaneous coronary intervention, drug-eluting stent, sex difference, myocardial infarction

About this article
Title

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-01-20

DOI

10.5603/CJ.a2021.0008

Pubmed

33634845

Keywords

coronary artery disease
percutaneous coronary intervention
drug-eluting stent
sex difference
myocardial infarction

Authors

Eun-Seok Shin
Eun Jung Jun
Jung-Kyu Han
Min Gyu Kong
Jeehoon Kang
Chengbin Zheng
Scot Garg
Young Jin Choi
Jang-Whan Bae
Kook-Jin Chun
Doo-Il Kim
Seung-Woon Rha
Sung Yun Lee
Jay Young Rhew
Seong-Ill Woo
Han Cheol Lee
Jin-Ok Jeong
Han-Mo Yang
Kyung Woo Park
Hyun-Jae Kang
Bon-Kwon Koo
In-Ho Chae
Hyo-Soo Kim

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