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Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-ST-elevation acute coronary syndromes (from the ACUITY trial).

Publication ,  Journal Article
Lansky, AJ; Mehran, R; Cristea, E; Parise, H; Feit, F; Ohman, EM; White, HD; Alexander, KP; Bertrand, ME; Desmet, W; Hamon, M; Stone, GW
Published in: Am J Cardiol
May 1, 2009

Women with non-ST-elevation acute coronary syndrome are at increased risk for ischemic and bleeding complications compared with men. We examined the impact of gender and antithrombotic therapy for non-ST-elevation acute coronary syndrome on outcomes in patients in the ACUITY trial. Patients were randomized to heparin (unfractionated or enoxaparin) plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin alone. We compared major bleeding unconnected to coronary artery bypass grafting, composite ischemia (death, myocardial infarction, or revascularization), and net clinical outcome (composite ischemia or bleeding) in (1) men versus women overall and undergoing percutaneous coronary intervention (PCI) and (2) women overall and undergoing PCI by antithrombotic strategy. Of 13,819 patients enrolled, 4,157 were women (30.1%). Women had similar 30-day composite ischemia (7% vs 8%, p = 0.07) but greater 30-day rates of major bleeding (8% vs 3% p <0.0001) and net clinical outcomes (13% vs 10% p <0.0001) than men. One-year composite ischemia and mortality was similar. In women, bivalirudin compared with heparin + GPI resulted in less 30-day major bleeding (5% vs 10%, p <0.0001) but similar composite ischemia (7% vs 6%, p = 0.15). No differences were observed in rates of 1-year composite ischemia or mortality in women who received bivalirudin versus heparin + GPI. Results were similar in women undergoing PCI. In conclusion, women had similar 30-day mortality and composite ischemia but higher net clinical adverse events due to more bleeding complications than men; 1-year mortality was similar for men and women. In women, bivalirudin monotherapy compared with a GPI-based strategy resulted in significantly decreased bleeding but similar rates of 1-year composite ischemia and mortality.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 1, 2009

Volume

103

Issue

9

Start / End Page

1196 / 1203

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Sex Factors
  • Severity of Illness Index
  • Risk Assessment
  • Reference Values
  • Recombinant Proteins
  • Proportional Hazards Models
  • Probability
 

Citation

APA
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ICMJE
MLA
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Lansky, A. J., Mehran, R., Cristea, E., Parise, H., Feit, F., Ohman, E. M., … Stone, G. W. (2009). Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-ST-elevation acute coronary syndromes (from the ACUITY trial). Am J Cardiol, 103(9), 1196–1203. https://doi.org/10.1016/j.amjcard.2009.01.030
Lansky, Alexandra J., Roxana Mehran, Ecatarina Cristea, Helen Parise, Frederick Feit, E Magnus Ohman, Harvey D. White, et al. “Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-ST-elevation acute coronary syndromes (from the ACUITY trial).Am J Cardiol 103, no. 9 (May 1, 2009): 1196–1203. https://doi.org/10.1016/j.amjcard.2009.01.030.
Lansky AJ, Mehran R, Cristea E, Parise H, Feit F, Ohman EM, et al. Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-ST-elevation acute coronary syndromes (from the ACUITY trial). Am J Cardiol. 2009 May 1;103(9):1196–203.
Lansky, Alexandra J., et al. “Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-ST-elevation acute coronary syndromes (from the ACUITY trial).Am J Cardiol, vol. 103, no. 9, May 2009, pp. 1196–203. Pubmed, doi:10.1016/j.amjcard.2009.01.030.
Lansky AJ, Mehran R, Cristea E, Parise H, Feit F, Ohman EM, White HD, Alexander KP, Bertrand ME, Desmet W, Hamon M, Stone GW. Impact of gender and antithrombin strategy on early and late clinical outcomes in patients with non-ST-elevation acute coronary syndromes (from the ACUITY trial). Am J Cardiol. 2009 May 1;103(9):1196–1203.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 1, 2009

Volume

103

Issue

9

Start / End Page

1196 / 1203

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Sex Factors
  • Severity of Illness Index
  • Risk Assessment
  • Reference Values
  • Recombinant Proteins
  • Proportional Hazards Models
  • Probability