Frequency of stent thrombosis risk at 5 years in women versus men with zotarolimus-eluting compared with sirolimus-eluting stent
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Published version
Author(s)
Type
Journal Article
Abstract
The prevalence of factors that are associated with an increased risk of stent thrombosis (ST), including smoking, diabetes mellitus, and small stent size, is different in women and men who underwent percutaneous coronary intervention. Thus, gender may potentially modify the relation between stent type and the incidence of ST during long-term follow-up. We explored the data of Patient Related Outcomes With Endeavor Versus Cypher stenting Trial (PROTECT) to evaluate this hypothesis. PROTECT randomized 2,061 women and 6,648 men who underwent percutaneous coronary intervention for various indications to Endeavor zotarolimus-eluting stenting (E-ZES) or Cypher sirolimus-eluting stenting (C-SES). Dual antiplatelet therapy was prescribed for at least 3 months. Data on study end points were collected until 5 years after randomization, including ST, death, and cardiovascular events. We analyzed end points and treatment effect (E-ZES vs C-SES) in relation to gender. Women were on average 4.7 years older (65.8 vs 61.1), had a higher prevalence of insulin-dependent diabetes mellitus, were less often smokers, and had a shorter total stent length than men. At discharge and throughout follow-up, a slightly lower fraction of women were using dual antiplatelet therapy. During 5-year follow-up, definite or probable ST was observed in 36 women (1.8%) and 152 men (2.4%; log-rank p = 0.15). E-ZES reduced the incidence of ST compared with C-SES in women (hazard ratio 0.58) and men (hazard ratio 0.61), with no evidence of heterogeneity (p = 0.89). In conclusion, in PROTECT, women and men had similar cumulative incidence of ST at 5 years after stent placement. The favorable effect of the study stent E-ZES over C-SES was not modified by gender.
Date Issued
2016-07-29
Date Acceptance
2016-07-05
Citation
American Journal of Cardiology, 2016, 118 (8), pp.1178-1186
ISSN
1879-1913
Publisher
Elsevier
Start Page
1178
End Page
1186
Journal / Book Title
American Journal of Cardiology
Volume
118
Issue
8
Copyright Statement
© 2016 The Authors. Published by Elsevier Inc. This is an open access article under a CC-BY Attribution Licence 4.0 (https://creativecommons.org/licenses/by/4.0/)
Identifier
PII: S0002-9149(16)31241-3
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
PERCUTANEOUS CORONARY INTERVENTION
RANDOMIZED-TRIALS
CLINICAL EVENTS
SEX-DIFFERENCES
ARTERY-DISEASE
OUTCOMES
IMPLANTATION
INSIGHTS
GENDER
PATHOGENESIS
Aged
Antibiotics, Antineoplastic
Coronary Artery Disease
Diabetes Mellitus
Drug-Eluting Stents
Female
Graft Occlusion, Vascular
Humans
Hypoglycemic Agents
Insulin
Male
Middle Aged
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Proportional Hazards Models
Sex Factors
Sirolimus
Thrombosis
Treatment Outcome
PROTECT Steering Committee and Investigators
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status
Published