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)

Autor: Michel E. Bertrand, Ecatarina Cristea, E. Magnus Ohman, Walter Desmet, Martial Hamon, Gregg W. Stone, Harvey D. White, Alexandra J. Lansky, Frederick Feit, Roxana Mehran, Karen P. Alexander, Helen Parise
Rok vydání: 2008
Předmět:
Male
Time Factors
medicine.medical_treatment
Severity of Illness Index
Electrocardiography
Reference Values
Cause of Death
Abciximab
Bivalirudin
Myocardial infarction
Angioplasty
Balloon
Coronary
Aged
80 and over
Age Factors
Hirudins
Middle Aged
Recombinant Proteins
Treatment Outcome
Cardiology
Drug Therapy
Combination
Female
Cardiology and Cardiovascular Medicine
medicine.drug
Adult
medicine.medical_specialty
Acute coronary syndrome
Platelet Glycoprotein GPIIb-IIIa Complex
Revascularization
Risk Assessment
Antithrombins
Drug Administration Schedule
Sex Factors
Internal medicine
medicine
Humans
Acute Coronary Syndrome
Enoxaparin
Aged
Probability
Proportional Hazards Models
Dose-Response Relationship
Drug
business.industry
Heparin
Percutaneous coronary intervention
Anticoagulants
medicine.disease
Survival Analysis
Peptide Fragments
Glycoprotein IIb/IIIa inhibitors
Conventional PCI
business
Follow-Up Studies
Zdroj: The American journal of cardiology. 103(9)
ISSN: 1879-1913
Popis: 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% p0.0001) and net clinical outcomes (13% vs 10% p0.0001) 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%, p0.0001) 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.
Databáze: OpenAIRE
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