Abstract 19691: Safety and Efficacy of New-Generation Drug-Eluting Stents in Women With Acute Myocardial Infarction: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration
Background: Women with acute myocardial infarction (AMI) undergoing mechanical reperfusion remain at increased risk of major adverse cardiac events (MACE) and mortality compared with male counterparts. New-generation drug-eluting stents (NG-DESs) are associated with improved thrombotic safety compared with early-generation DES (EG-DES). Whether the benefits of NG-DES are preserved in women with acute MI remains unclear.
Methods: We pooled patient-level data of female participants from 26 randomized trials of DES.
Only women presenting with an acute coronary syndrome (ACS) were included in this analysis. Study population was categorized according to presentation with either unstable angina (UA) versus AMI. Acute MI included non-ST-elevation MI (NSTEMI) or ST-elevation MI (STEMI). Primary endpoint of interest was MACE, defined as the composite of death, MI or target lesion revascularization (TLR) at 3 years of follow-up. NG- versus EG-DES were compared with Cox proportional hazard models using trial identifier as a random effect.
Results: Out of 11,557 women included in the pooled dataset, 4,373 (37.8%) women had an ACS as clinical presentation. Of these, 2,176 (49.8%) presented with an AMI. Compared with EG-DES, a graded absolute benefit with NG-DES was observed in the transition from UA, to NSTEMI, to STEMI (Figure). In women with AMI, NG-DES were associated with lower risk of MACE (14.9% vs. 18.4%; adjusted hazard ratio: 0.78, 95% confidence interval: 0.61 to 0.99), TLR (5.26% vs. 7.6%; adjusted HR: 0.70; 95% CI: 0.47 to 1.05), and definite or probable ST (1.33% vs. 4.12%; adjusted HR 0.36, 95% CI 0.19-0.69). The magnitude and direction of the effect of NG-DES was uniform between women with versus without AMI presentation, without evidence of interaction (for MACE pint=0.59; for TLR pint=0.91; for ST pint=0.31).
Conclusion: Newer generation DES are associated with consistent and durable benefits over 3 years in women presenting with AMI.
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- © 2016 by American Heart Association, Inc.