Abstract 5581: Cardiovascular Outcomes of Women and Men with Acute Coronary Syndromes and Angiographically Confirmed Epicardial Coronary Artery Disease in TRITON-TIMI 38
Among patients with clinically diagnosed ACS, significant epicardial CAD is less commonly found in women than men. In this setting, some studies suggest a protective effect of female gender, particularly with UA or NSTEMI. We studied a large cohort of patients with ACS and angiographically confirmed epicardial CAD and compared the cardiovascular (CV) outcomes of women and men. TRITON-TIMI 38 randomized 13,608 subjects (26% women) to receive prasugrel or clopidogrel for 6 – 15 months. By design, all subjects in this trial had either a STEMI or UA/NSTEMI with CAD on angiography. Women were older than men (66 vs. 59 years P<0.001) and more likely to have diabetes, hypertension, and dyslipidemia (P<0.01). Women experienced higher absolute rates of CV death than men (2.9 vs 2.0%, P=0.01, Figure⇓). After adjustment for presenting features including age, women were at similar risk as men for CV death following an ACS (adj HR 1.08, 95% CI 0.80 – 1.46), as well as UA, NSTEMI, and STEMI evaluated separately (Figure⇓). Women were at similar adjusted risk of non-CABG TIMI major bleeding (adj HR 1.20, 95% CI 0.90 – 1.61) but at higher risk of non-CABG TIMI minor bleeding (adj HR 2.15, 95% CI 1.66 – 2.80). No significant interaction between sex and treatment (prasugrel versus clopidogrel) was observed for CV mortality or bleeding. We found that the mortality risk of women with confirmed epicardial CAD was at least as high as that of men following UA, NSTEMI, and STEMI. Our findings suggest that previously reported lower rates of adjusted CV mortality for women versus men following UA or NSTEMI may be related to the lower prevalence of epicardial disease in those cohorts.