Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban

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• 作者：Giuseppe  ; Ferrante MD ; PhD^a ;   ; ^o ;   ; ^{vlgmrc@unife.it} ; Patrizia  ; Presbitero MD^a ;   ; ^o ; Elena  ; Corrada MD^a ; Gianluca  ; Campo MD^b ; Leonardo  ; Bolognese MD^c ; Corrado  ; Vassanelli MD^d ; Salvatore  ; Colangelo MD^e ; Nicoletta  ; De Cesare MD^f ; Alfredo  ; E. Rodriguez MD ; PhD^g ; Ezio  ; Bramucci MD^h ; Raul  ; Moreno MDⁱ ; Tommaso  ; Piva MD^j ; Imad  ; Sheiban MD^k ; Giampaolo  ; Pasquetto MD^l ; Francesco  ; Prati MD^m ; Marco S.  ; Nazzaro MD ; PhDⁿ ; Roberto  ; Ferrari MD ; PhD^b ; Marco  ; Valgimigli MD ; PhD^b ;   ; ^{vlgmrc@unife.it}
• 刊名：American Heart Journal
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：163
• 期：1
• 页码：104-111
• 全文大小：419 K

文摘

Objectives

We assessed the relation between female sex and sirolimus-eluting stent (SES) use on long-term outcomes in acute myocardial infarction.

Background

There are no data on sex-specific differences in long-term benefit of SES use compared with bare-metal stent (BMS) use among patients undergoing primary percutaneous coronary interventions.

Methods

We performed a post hoc analysis of the MULTISTRATEGY trial. Hazard ratios (HRs) of events with 95 % CI for sex and stent type were computed using Cox proportional regression with adjustment for confounders.

Results

A total of 744 patients, 64 years old (55-73 years old), 179 (24.1 % ) women, were enrolled. After a follow-up of 1,080 days, SES use was associated with a significant reduction of major adverse cardiovascular events, that is, the composite of all-cause death, reinfarction, or clinically driven target vessel revascularization (TVR) (13.9 % vs 23.6 % , adjusted HR 0.62, 95 % CI 0.41-0.94, P = .026) and of TVR (6.1 % vs 15.1 % , adjusted HR 0.35, 95 % CI 0.19-0.63, P < .001) in men. Conversely, SES use was not associated to a better outcome among women (major adverse cardiovascular events 21.9 % in SES vs 18.2 % in the BMS group, adjusted HR 1.27, 95 % CI 0.53-3.02, P = .59; TVR 6.6 % vs 9.1 % , adjusted HR 0.62, 95 % CI 0.17-2.21, P = .46).

Conclusions

In this analysis, the clinical benefit of SES use, over BMS, at 3-year follow-up was restricted to men and was not observed among women.