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Rev Esp Cardiol (Engl Ed). 2015 May;68(5):382-9. doi: 10.1016/j.rec.2014.09.001. Epub 2014 Oct 29.

Sex-related Impact on Clinical Outcome of Everolimus-eluting Versus Bare-metal Stents in ST-segment Myocardial Infarction. Insights From the EXAMINATION Trial.

Author information

1
Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain.
2
Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain.
3
Servicio de Cardiología, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain.
4
Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
5
Servicio de Cardiología, Hospital Clínic, IDIBAPS, Barcelona, Spain. Electronic address: masabate@clinic.ub.es.

Abstract

INTRODUCTION AND OBJECTIVES:

The use of second-generation drug-eluting stents compared with bare-metal stents in patients with ST-segment elevation myocardial infarction reduces the rate of major adverse cardiac events. We aimed to evaluate the impact of sex on the performance of everolimus-eluting stents vs bare-metal stents in ST-segment elevation myocardial infarction at 2-year follow-up.

METHODS:

This is a sub-study of the EXAMINATION trial that randomized 1498 patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention to everolimus-eluting or bare-metal stents. Primary end point was combined all-cause death, any recurrent myocardial infarction, and any revascularization. All end points were analyzed according to sex at 2-year follow-up.

RESULTS:

Of 1498 patients included in the trial, 254 (17.0%) were women. Women were older and had higher prevalence of hypertension and lower prevalence of smoking compared with men. In contrast with men, stent diameter was smaller in women. After multivariate analysis, the primary end point was similar between women and men (hazard ratio=0.95; 95% confidence interval, 0.66-1.37), and among women, between those treated with bare-metal vs everolimus-eluting stents (hazard ratio=2.48; 95% confidence interval, 0.95-6.46). Women showed a lower rate of repeat revascularization than men (hazard ratio=0.55; 95% confidence interval, 0.32-0.95) despite worse baseline characteristics. This difference was driven by better performance of the everolimus-eluting stent in women.

CONCLUSIONS:

Despite poorer baseline clinical characteristics, women with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention showed outcomes similar to men. The use of everolimus-eluting stents may represent an added value in women as it showed a reduced rate of repeated revascularization compared to men.

KEYWORDS:

Infarto de miocardio; Myocardial infarction; Sex; Sexo; Stent

PMID:
25444377
DOI:
10.1016/j.rec.2014.09.001
[Indexed for MEDLINE]

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