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Short-versus long-term Dual Antiplatelet therapy after drug-eluting stent implantation in women versus men: A sex-specific patient-level pooled-analysis of six randomized trials.
- Source :
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Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2017 Feb 01; Vol. 89 (2), pp. 178-189. Date of Electronic Publication: 2016 Jul 18. - Publication Year :
- 2017
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Abstract
- Background: Whether the efficacy and safety of dual antiplatelet therapy (DAPT) are uniform between sexes is unclear. We sought to compare clinical outcomes between short- (≤6 months) versus long-term (≥1 year) DAPT after drug-eluting stent (DES) placement in women and men.<br />Methods and Results: We pooled individual patient data from 6 randomized trials of DAPT (EXCELLENT, OPTIMIZE, PRODIGY, RESET, SECURITY, ITALIC PLUS). The primary outcome was 1-year risk of major adverse cardiac events (MACE). The main secondary outcome was 1-year risk of any bleeding. Out of the 11,473 randomized patients included in the pooled dataset, 3,454 (30%) were females. At 1-year follow-up, women had higher risk of MACE (3.6% vs. 2.8%; P = 0.01) but similar risk of bleeding (1.9% vs. 1.6%; P = 0.16) as compared with men. Compared with long-term DAPT, short-term DAPT was associated with similar rates of MACE in both women (HR 0.88; 95% CI 0.62-1.25) and men (HR 1.25; 95% CI 0.95-1.6; P interaction = 0.08)]. At 1-year follow-up, short-term DAPT was associated with lower rates of bleeding as compared with long-term DAPT in both women (HR 0.84; 95% CI 0.51-1.37) and men (HR 0.58; 95% CI 0.40-0.84; P-interaction = 0.25). The presence of MVD was associated with higher MACE rates in the short-term DAPT group in women (HR: 1.16; CI 0.60-2.23) and men (HR: 2.29; CI 1.22-4.29; P interaction = 0.25).<br />Conclusions: Short-term DAPT is associated with similar rates of MACE but lower risk of bleeding when as compared with prolonged DAPT. There was no significant difference between sexes in the population studied. © 2016 Wiley Periodicals, Inc.<br /> (© 2016 Wiley Periodicals, Inc.)
- Subjects :
- Aged
Coronary Thrombosis etiology
Drug Administration Schedule
Female
Hemorrhage chemically induced
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction etiology
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Platelet Aggregation Inhibitors adverse effects
Proportional Hazards Models
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
Drug-Eluting Stents
Percutaneous Coronary Intervention instrumentation
Platelet Aggregation Inhibitors administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 89
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 27426936
- Full Text :
- https://doi.org/10.1002/ccd.26653