Abstract 18379: Impact of Gender on Adverse Cardiovascular Events Following Percutaneous Coronary Intervention: Pooled Analysis from the SPIRIT II, III and IV trials
Background: Female gender is a consistent and strong correlate of increased cardiovascular risk following percutaneous coronary intervention (PCI). Emerging data suggest that 2nd generation drug-eluting stents (DES) may improve event-free survival compared to 1st generation DES. Whether or not this applies to both sexes is unknown.
Methods: The SPIRIT II, III and IV randomized controlled trials compared the second-generation everolimus-eluting stent (EES) to the first-generation paclitaxel-eluting stent (PES). Summary-level data from the latest follow-up year of each study was pooled using meta-analytic techniques. We evaluated the overall and differential impact of gender on adverse events stratified by DES type. Relative risks and 95% confidence intervals were calculated for the following outcomes: definite or probable stent thrombosis (ST), target lesion revascularization (TLR), myocardial infarction (MI), major adverse cardiovascular events (MACE) and cardiac death.
Results: Women (n=1583, 31.7%), were older, more often diabetic and less likely to have multivessel disease compared to men (n=3405, 68.3%). After a weighted mean follow-up of 2.3 years, among patients receiving PES, the incidence of MACE (13.3% vs. 10.1%, p=0.04) was significantly higher while rates of MI (5.3% vs. 4.0%, p=0.19) and TLR (8.4% vs. 6.6%, p=0.17) were modestly higher among women compared to men. In contrast, MACE rates were lower with EES than PES in both men and women, and outcomes were similar in men and women receiving EES (Table). Rates of ST (0.5% vs. 0.7%, p=0.65) and cardiac death (0.9% vs. 1.0%, p=0.95) in EES-treated patients did not differ in women vs. men, respectively.
Conclusions: In this pooled analysis of RCT, adverse cardiovascular events were modestly higher among women compared to men treated with PES. In contrast, outcomes were improved with EES in both men and women such that female sex was no longer associated greater MACE.
- © 2012 by American Heart Association, Inc.