Female gender was an independent predictor of major adverse cardiac events at 12 months after mTOR-inhibitor DES implantation compared to males (25% vs 11%; HR 3.70; 95% CI 1.46-9.36; p=0.006).
Cohort (n=138)
Does female gender increase the risk of major adverse cardiac events in patients with first manifestation of coronary artery disease undergoing percutaneous coronary intervention with mTOR-inhibitor drug-eluting stents?
Women experiencing their first manifestation of coronary artery disease have a significantly higher risk of major adverse cardiac events compared to men following mTOR-inhibitor drug-eluting stent implantation.
Effect estimate: HR 3.70 (95% CI 1.46-9.36)
Absolute Event Rate: 25% vs 11%
p-value: p=0.006
BACKGROUND: Women have a worse outcome than men after percutaneous coronary intervention (PCI). However, in the drug-eluting stent (DES) era, limited data are available about the impact of gender-related differences on clinical outcome. Furthermore, many series have also included patients previously treated by coronary-artery bypass grafts or PCI, which may bias the evaluation of DES-related clinical events at follow up. We aimed to assess the impact of gender on clinical outcomes in a consecutive series of patients at first manifestation of coronary artery disease (CAD) undergoing PCI with mTOR-inhibitor DES. METHODS AND RESULTS: A total of 138 consecutive patients (age 64 ± 13 years, female gender 29%) undergoing successful mTOR-inhibitor DES implantation sirolimus-eluting stent (SES); zotarolimus-eluting stent (ZES); and everolimus-eluting stent (EES) for the treatment of stable chronic angina or an acute coronary syndrome, as their first clinical manifestation of CAD, were prospectively enrolled between February 2008 and May 2009. Major adverse cardiac events (MACE), defined as a combination of cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization (TVR) at 12-month follow up, constituted the endpoint of the study. Fifty-one (37%) patients received SES; 46 (33%) patients received ZES; and 41 (30%) patients received EES. At follow up, 21 (15%) patients experienced a MACE. Three (2%) patients had cardiac death, five (4%) had MI, while 13 (9%) patients underwent clinically driven TVR. MACE occurred more frequently in females than males 10 (25%) vs. 11 (11%), p = 0.05. At Cox regression analysis, the only independent predictors of MACE were female gender and implantation of more than one stent hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.46-9.36, p = 0.006; HR 1.26, 95% CI 0.99-2.74, p = 0.01, respectively. CONCLUSIONS: In conclusion, our finding suggests that women may have a worse outcome as compared with men after mTOR-inhibitor DES implantation.
Niccoli et al. (Fri,) conducted a cohort in First manifestation of coronary artery disease (CAD) (n=138). Female gender vs. Male gender was evaluated on Major adverse cardiac events (MACE), defined as a combination of cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization (TVR) (HR 3.70, 95% CI 1.46-9.36, p=0.006). Female gender was an independent predictor of major adverse cardiac events at 12 months after mTOR-inhibitor DES implantation compared to males (25% vs 11%; HR 3.70; 95% CI 1.46-9.36; p=0.006).