Sex difference in chest pain after implantation of newer generation coronary drug-eluting stents: a patient-level pooled analysis from the TWENTE and DUTCH PEERS trials

Marlies M. Kok, Liefke C. van der Heijden, Hanim Sen, Peter W. Danse, Marije M. Löwik, Rutger L. Anthonio, J. (Hans) W. Louwerenburg, Frits H.A.F. de Man, Gerard C.M. Linssen, Maarten Joost IJzerman, Catharina Jacoba Maria Doggen, Angela H.E.M. Maas, Roxana Mehran, Clemens von Birgelen

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Abstract

Objectives: This study sought to assess sex differences in chest pain after percutaneous coronary intervention (PCI) with newer generation drug-eluting stents (DES).

Background: Sex-based data on chest pain after PCI with DES are scarce.

Methods: The authors performed a patient-level pooled analysis of the TWENTE and DUTCH PEERS randomized trials, in which patients were treated with newer generation permanent polymer-coated DES. At 1 and 2 years, clinical follow-up was available in 99.8% and patient-reported chest pain data in 94.1% and 93.6%, respectively.

Results: Among all 3,202 patients, the 871 (27.2%) women were older (67.5 ± 10.2 years vs. 62.8 ± 10.6 years; p < 0.001) and had more cardiovascular risk factors: diabetes (24.2% vs. 17.8%; p < 0.001), hypertension (63.6% vs. 51.6%; p < 0.001), and positive family history (54.5% vs. 50.1%; p = 0.03). At 1- and 2-year follow-up, women reported more clinically relevant chest pain (16.3% vs. 10.5%; p < 0.001, and 17.2% vs. 11.1%; p < 0.001, respectively). Multivariate analysis demonstrated that female sex independently predicted clinically relevant chest pain at 1- and 2-year follow-up both during daily activities and at minimum physical exertion/at rest (1 year adjusted odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.2 to 2.4; p = 0.002; and adjusted OR: 1.8; 95% CI: 1.3 to 2.5; p < 0.001; 2-year adjusted OR: 1.8; 95% CI: 1.3 to 2.6; p < 0.001; and adjusted OR: 1.7; 95% CI: 1.3 to 2.3; p = 0.001). Nevertheless, the 2-year rates of death, myocardial infarction, revascularization, stent thrombosis, and various composite clinical endpoints were similar for both sexes.

Conclusions: Although the incidence of adverse cardiovascular events was low and similar for both sexes, women showed a statistically significantly higher prevalence of clinically relevant chest pain, which might be largely related to mechanisms other than epicardial coronary obstruction.

Original languageEnglish
Pages (from-to)553-561
Number of pages9
JournalJACC : cardiovascular interventions
Volume9
Issue number6
DOIs
Publication statusPublished - 2016

Keywords

  • Chest pain
  • Sex analysis
  • Newer generation drug-eluting stent(s)
  • Percutaneous Coronary Intervention (PCI)
  • Randomized clinical trial
  • Second-generation drug-eluting stent(s)

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