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Am J Cardiol. 2015 Sep 15;116(6):845-52. doi: 10.1016/j.amjcard.2015.06.010. Epub 2015 Jun 24.

Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents.

Author information

1
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
2
Humanitas Research Hospital, Rozzano, Milan, Italy.
3
Columbia University Medical Center, New York City, New York.
4
Département Hospitalo Universitaire Fibrose, Inflammation et REmodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U-1148, Paris, France.
5
Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium.
6
Maasstad Hospital, Rotterdam, The Netherlands.
7
University Hospital Basel, Basel, Switzerland.
8
Bern University Hospital, Bern, Switzerland.
9
ErasmusMC, Rotterdam, The Netherlands.
10
Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France.
11
University of Geneva, Geneva, Switzerland.
12
Columbia University Medical Center, New York City, New York; Shaare Zedek Medical Center, Jerusalem, Israel.
13
Piedmont Heart Institute, Atlanta, Georgia.
14
Thoraxcentrum Twente, Enschede, The Netherlands.
15
Gentofte University Hospital, Hellerup, Denmark.
16
Kyoto University Graduate School of Medicine, Kyoto, Japan.
17
Imperial College Healthcare NHS Trust, London, United Kingdom.
18
Hoag Memorial Hospital Presbyterian, Newport Beach, California.
19
Ohio State University Medical Center, Columbus, Ohio.
20
Society of Cardiovascular Angiography and Interventions, Washington, DC.
21
Seoul National University Main Hospital, Seoul, Korea.
22
University of Ferrara, Ferrara, Italy.
23
Herzzentrum, Munich, Germany.
24
San Raffaele Scientific Institute, Milan, Italy.
25
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York. Electronic address: Roxana.Mehran@mountsinai.org.

Abstract

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.

PMID:
26174605
DOI:
10.1016/j.amjcard.2015.06.010
[Indexed for MEDLINE]
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