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Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study.

Publication ,  Journal Article
Chandrasekhar, J; Baber, U; Sartori, S; Faggioni, M; Aquino, M; Kini, A; Weintraub, W; Rao, S; Kapadia, S; Weiss, S; Strauss, C; Toma, C ...
Published in: Catheter Cardiovasc Interv
March 1, 2017

BACKGROUND: Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under-treatment. We sought to compare the 1-year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort. METHODS: PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression. RESULTS: The study cohort included 4,851 patients of which 1,162 (24.0%) were women and 3,689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one-third of patients (31.8% in men vs. 28.1% in women, P = 0.01). Unadjusted, 1-year MACE (21.1% vs. 16.2%, P < 0.001) and bleeding (3.6% vs. 2.2%, P = 0.01) was significantly higher in women compared with men, but these results were no longer significant after adjustment for risk (HR 1.13, 95% CI 0.94-1.36 for MACE and HR 1.31, 95% CI 0.85-2.04 for bleeding). CONCLUSION: Women ≤ 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1-year MACE and bleeding than male sex, findings that are attributable to baseline differences. © 2016 Wiley Periodicals, Inc.

Duke Scholars

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

March 1, 2017

Volume

89

Issue

4

Start / End Page

629 / 637

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Ticlopidine
  • Survival Rate
  • Sex Factors
  • Sex Distribution
  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Prasugrel Hydrochloride
 

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Chandrasekhar, J., Baber, U., Sartori, S., Faggioni, M., Aquino, M., Kini, A., … Mehran, R. (2017). Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study. Catheter Cardiovasc Interv, 89(4), 629–637. https://doi.org/10.1002/ccd.26606
Chandrasekhar, Jaya, Usman Baber, Samantha Sartori, Michela Faggioni, Melissa Aquino, Annapoorna Kini, William Weintraub, et al. “Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study.Catheter Cardiovasc Interv 89, no. 4 (March 1, 2017): 629–37. https://doi.org/10.1002/ccd.26606.
Chandrasekhar J, Baber U, Sartori S, Faggioni M, Aquino M, Kini A, et al. Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study. Catheter Cardiovasc Interv. 2017 Mar 1;89(4):629–37.
Chandrasekhar, Jaya, et al. “Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study.Catheter Cardiovasc Interv, vol. 89, no. 4, Mar. 2017, pp. 629–37. Pubmed, doi:10.1002/ccd.26606.
Chandrasekhar J, Baber U, Sartori S, Faggioni M, Aquino M, Kini A, Weintraub W, Rao S, Kapadia S, Weiss S, Strauss C, Toma C, Muhlestein B, DeFranco A, Effron M, Keller S, Baker B, Pocock S, Henry T, Mehran R. Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study. Catheter Cardiovasc Interv. 2017 Mar 1;89(4):629–637.
Journal cover image

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

March 1, 2017

Volume

89

Issue

4

Start / End Page

629 / 637

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Ticlopidine
  • Survival Rate
  • Sex Factors
  • Sex Distribution
  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Prasugrel Hydrochloride