Sex Differences in 10-Year Outcomes Following STEMI

医学 临床终点 心肌梗塞 内科学 心脏病学 血运重建 临床试验
作者
Rami Gabani,Francesco Spione,Víctor Arévalos,Nadine Grima Sopesens,Luis Ortega‐Paz,Josep Gómez-Lara,Víctor Jiménez Díaz,Marcelo Jiménez,Pilar Jiménez‐Quevedo,Roberto Diletti,Javier Pineda,Gianluca Campo,Antonio Silvestro,Jaume Maristany,Xacobe Flores,Loreto Oyarzabal,Guillermo Bastos‐Fernandez,Andrés Íñiguez,Antonio Serra,Javier Escaned,Alfonso Ielasi,Maurizio Tespili,Mattie Lenzen,Nieves Gonzalo,Pascual Bordes,Matteo Tebaldi,Simone Biscaglia,Soheil Al‐Shaibani,Rafael Romaguera,Joan Antoni Gómez‐Hospital,Josep Rodes-Cabau,Patrick W. Serruys,Manel Sabaté,Salvatore Brugaletta
出处
期刊:Jacc-cardiovascular Interventions [Elsevier BV]
卷期号:15 (19): 1965-1973 被引量:6
标识
DOI:10.1016/j.jcin.2022.07.038
摘要

Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether sex plays a role in very long term outcomes.The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by sex.EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to sex. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age.Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints.At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and sex-specific risk factor control and targeted treatment. (10-Years Follow-Up of the EXAMINATION Trial [EXAMINAT10N]; NCT04462315).
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