Abstract 12351: Sex Differences in Neointimal Hyperplasia Following Zotarolimus-Eluting Stent Implantation: Potential Impact of Drug and Carrier Matrix
Background: Recent studies have reported sex differences in clinical outcomes following zotarolimus-eluting stent (ZES) implantation. The aim of this study was to investigate possible impact of drug and carrier matrix on sex differences in arterial responses, using ZES with an identical drug and stent platform but with different carrier matrixes (ENDEAVOR and RESOLUTE) as compared with identical-platform bare metal stents (BMS, Driver).
Methods: Volumetric IVUS was performed in 625 lesions (391 ENDEAVOR: 149 RESOLUTE: 85 BMS) 8-9 months after stent implantation (female: 29%). Neointimal obstruction was calculated as neointimal volume divided by stent volume (%). Cross-sectional narrowing (CSN) was defined as neointimal area divided by stent area (%).
Results: Overall, neointimal obstruction at follow-up significantly differed among 3 stents (BMS: 29.4±17.2%, ENDEAVOR: 17.4±10.6%, RESOLUTE: 4.4±5.0%, P<0.0001). Neointimal obstruction and max CSN were significantly lower in women compared with men in ENDEAVOR, with similar trends observed in RESOLUTE (Figure). Conversely, these parameters tended to be higher in women than men receiving BMS. In multivariate analysis including clinical, procedural, and imaging variables, female gender was independently associated with lower neointimal obstruction (P=0.025) and max CSN (P=0.004) for ZES but not for BMS. Sex had a significant interaction effect with the use of drug (ZES vs. BMS) for both neointimal obstruction (P=0.001) and max CSN (P=0.003), whereas no interaction was detected between polymer type (ENDEAVOR vs RESOLUTE) and sex.
Conclusion: Drug and polymer differences can affect not only overall magnitude of neointimal suppression, but also arterial responses in varying degrees depending on patient gender. Female patients appear to have enhanced neointimal suppression with ZES, but such sex differences seem less pronounced when BioLinx is used in place of phosphorylcholine.
- © 2011 by American Heart Association, Inc.