Sex‐Related Differences in Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention: A Patient‐Level Pooled Analysis From 4 Postapproval Studies

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Karine Ruster¹  Jin Wang¹  Marco Valgimigli²  Deepak L. Bhatt³  Raj Makkar⁴  Dominick J. Angiolillo⁵  Mitchell Krucoff⁶  Ashok Seth⁷  Sripal Bangalore⁸  Shigeru Saito⁹  James Hermiller^1,10  Ken Kozuma^1,11  Paul Guedeney^1,12  Davide Cao^1,12  Sabato Sorrentino^1,12  Ridhima Goel^1,12  Rishi Chandiramani^1,12  Moritz Blum^1,12  Roxana Mehran^1,12  Bimmer E. Claessen^1,12  Anastasios Roumeliotis^1,12  Franz‐Josef Neumann^1,13  Junbo Ge^1,14 

[1] Abbott Vascular Santa Clara CA;Bern University Hospital Bern Switzerland;Brigham and Women’s Hospital Heart and Vascular Center Harvard Medical School Boston MA;Cedars‐Sinai Medical Center Los Angeles CA;Division of Cardiology University of Florida College of Medicine‐Jacksonville Jacksonville FL;Duke University Medical Center Durham NC;Fortis Escorts Heart Institute New Delhi India;New York University Langone Medical Center New York NY;Shonan Kamakura General Hospital Kamakura Japan;St Vincent’s Medical Center of Indiana Indianapolis IN;Teikyo University Tokyo Japan;The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY;University of Freiburg Germany;Zhongshan Hospital Fudan University Shanghai China;

关键词: everolimus‐eluting stent;    high bleeding risk;    major bleeding;    percutaneous coronary intervention;    sex;   

DOI  :  10.1161/JAHA.119.014611

来源: DOAJ

【 摘 要 】

Background Women have been associated with higher rates of recurrent events after percutaneous coronary intervention than men, possibly attributable to advanced age at presentation and greater comorbidities. These factors also put women at higher risk of bleeding, which may influence therapeutic strategies and clinical outcomes. Methods and Results We performed a patient‐level pooled analysis of 4 postapproval registries to evaluate sex‐related differences in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention. HBR required fulfillment of at least 1 major or 2 minor criteria of the Academic Research Consortium definition. Outcomes of interest were major bleeding and major adverse cardiac events (composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis). Of the total 10 502 patients, 2832 (27.0%) were women. The prevalence of HBR was higher in women compared with men (29.0% versus 20.5%, P<0.0001). Women at HBR were older and had more comorbidities, while men at HBR were more often smokers, with prior myocardial infarction and more complex coronary lesions. At 4 years, women at HBR had significantly higher major bleeding compared with men at HBR (10.8% versus 6.2%, P<0.0001); however, this difference was attenuated after multivariable adjustment (hazard ratio, 0.92; 95% CI, 0.41–2.08). Major adverse cardiac event rates between groups were similar (12.2% versus 12.6%, P=0.82) and remained consistent after adjustment (hazard ratio, 0.64; 95% CI, 0.32–1.28). Conclusions The prevalence of HBR was higher in women compared with men, with considerable differences in the distribution of criteria. Women at HBR experienced higher rates of major bleeding but similar major adverse cardiac event rates compared with men at HBR at 4 years.

【 授权许可】

Unknown