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Sex‐related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study
Author(s) -
Chandrasekhar Jaya,
Baber Usman,
Sartori Samantha,
Faggioni Michela,
Aquino Melissa,
Kini Annapoorna,
Weintraub William,
Rao Sunil,
Kapadia Samir,
Weiss Sandra,
Strauss Craig,
Toma Catalin,
Muhlestein Brent,
DeFranco Anthony,
Effron Mark,
Keller Stuart,
Baker Brian,
Pocock Stuart,
Henry Timothy,
Mehran Roxana
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26606
Subject(s) - medicine , percutaneous coronary intervention , prasugrel , mace , hazard ratio , conventional pci , myocardial infarction , acute coronary syndrome , clopidogrel , proportional hazards model , cohort , retrospective cohort study , cardiology , confidence interval
Background Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under‐treatment. We sought to compare the 1‐year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort. Methods PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression. Results The study cohort included 4,851 patients of which 1,162 (24.0%) were women and 3,689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one‐third of patients (31.8% in men vs. 28.1% in women, P = 0.01). Unadjusted, 1‐year MACE (21.1% vs. 16.2%, P < 0.001) and bleeding (3.6% vs. 2.2%, P = 0.01) was significantly higher in women compared with men, but these results were no longer significant after adjustment for risk (HR 1.13, 95% CI 0.94–1.36 for MACE and HR 1.31, 95% CI 0.85–2.04 for bleeding). Conclusion Women ≤ 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1‐year MACE and bleeding than male sex, findings that are attributable to baseline differences. © 2016 Wiley Periodicals, Inc.