Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non–ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

Gennaro Giustino, Usman Baber, Giulio Guiseppe Stefannini, Melissa Aquino, Gregg W. Stone, Samantha Sartori, Philippe G. Steg, William Wijns, Pieter C. Smits, Raban V. Jeger, Martin B. Leon, Stephan Windecker, Patrick W. Serruys, Marie-Claude Morice, Edoardo Camenzind, Giora Weisz, David E. Kandzari, George D. Dangas, Ioannis Mastoris, Clemens von BirgelenSoren Galatius, Takeshi Kimura, Ghada W. Mikhail, Dipti Itchhaporia, Laxmi Mehta, Rebecca Ortega, Hyo-Soo Kim, Marco Valgimigli, Adnan Kastrati, Alaide Chieffo, Roxana Mehran

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)

Abstract

The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non–ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.
Original languageEnglish
Pages (from-to)845-852
JournalAmerican journal of cardiology
Volume116
Issue number6
DOIs
Publication statusPublished - 2015

Keywords

  • METIS-313896
  • IR-98765

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