Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis

Abstract

ObjectivesTo evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI).SettingsA prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery.ParticipantsBetween September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included.InterventionsPatients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor.OutcomesThe main objective was to study the association between gender and primary and secondary outcomes of the main study with a focus on the clinical efficacy and safety outcomes. Primary outcome: the proportion of patients who did not have 70% resolution of ST-segment elevation and did not meet the criteria for Thrombolysis In Myocardial Infarction (TIMI) flow 3 at initial angiography. Secondary outcome: the composite of death, MI, stent thrombosis, stroke or urgent revascularisation and major or minor bleeding at 30 days.ResultsWomen were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery. Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51). After adjustment, the difference was attenuated but remained statistically significant (HR 2.08, 95% CI 1.03 to 4.20). The incidence of major bleeding events was twofold to threefold higher in women compared with men. In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3–5 HR 1.45, 95% CI 0.72 to 2.91). There was no interaction between gender and efficacy or safety of randomised treatment.ConclusionIn patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could mainly be explained by older age and clustering of comorbidities.Clinical trial registrationNCT01347580;Post-results.

Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era

“…There have been several studies demonstrating gender differences in in-hospital outcomes in patients undergoing PCI. Although some studies have reported higher event rates in women than in men, [6–13] several studies have failed to show gender differences because gender differences in in-hospital outcomes decreased or disappeared after adjustment for age, comorbidity, treatment, and procedure. [14–20] Our study also demonstrated that in unadjusted analyses, the risk of in-hospital mortality in women disappeared after controlling for baseline differences in age, comorbidities, disease severity, and angiographic and procedural characteristics.…”

“…Although there are several recent investigations on gender issue in the DES era, their study populations were restricted to patients with acute coronary syndrome, and their results are still conflicting. [12,13,19,20] Therefore, results of our study may deserve clinical attention, because we used the recent database of PCI registry reflecting the current practice of interventional cardiology among unselected patients with CAD. In addition, most of the previous studies were performed in Western countries, [6–13,15–20] and the gender issue on PCI outcome among Asian patients remained to be evaluated.…”

“…[6–11,14–18] Although there are several recent investigations on gender issue in the drug-eluting stent (DES) era, their study population was mainly restricted to patients with acute coronary syndrome. [12,13,19,20] Moreover, most studies reporting the gender issue were conducted in Western countries, [6–13,15–20] and Asian data is scarce. [14]…”

Gender Features in the Assessment of Insulin Resistance in Patients With Type 2 Diabetes and Its Combination With Metabolic Syndrome.

“…It is known that gender differencis definitely associated with mortality [15], and such diseases as atherosclerosis that occurs in men early enough (at about 30 years of age), and in women only after menopause. In this case, it is believed that female sex hormones, primarily estrogens, play a key role in antiatherosclerotic protection [12].…”

Early Prescription of Platelet P2y12 Receptor Inhibitors to Patients With Acute Coronary Syndrome: A Benefit or a Harm?

“…При этом отсутствовали различия в частоте геморрагических осложнений между группами пациентов, получавших антиагрегант на догоспитальном или госпитальном этапах. Не было отмечено гендерных различий при анализе эффективности и безопасности догоспитального назначения тикагрелора [18]. Недавно опубликованы результаты дополнительного анализа исследования ATLANTIC, касающегося преимущества догоспитального назначения тикагрелора у пожилых больных (старше 75 лет) [19].…”