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.
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| 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.
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| Authors | Gennaro Giustino, Usman Baber, Giulio Giuseppe Stefanini, Melissa Aquino, Gregg W Stone, Samantha Sartori, Philippe Gabriel Steg, William Wijns, Pieter C Smits, Raban V Jeger, Martin B Leon, Stephan Windecker, Patrick W Serruys, Marie-Claude Morice, Edoardo Camenzind, Giora Weisz, David Kandzari, George D Dangas, Ioannis Mastoris, Clemens Von Birgelen, Soren Galatius, Takeshi Kimura, Ghada Mikhail, Dipti Itchhaporia, Laxmi Mehta, Rebecca Ortega, Hyo-Soo Kim, Marco Valgimigli, Adnan Kastrati, Alaide Chieffo, Roxana Mehran |
| Journal | The American journal of cardiology (Am J Cardiol) Vol. 116 Issue 6 Pg. 845-52 (Sep 15 2015) ISSN: 1879-1913 [Electronic] United States |
| PMID | 26174605 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't) |
| Copyright | Published by Elsevier Inc. |
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