Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents
Giustino, G.; Baber, U.; Stefanini, G.Giuseppe.; Aquino, M.; Stone, G.W.; Sartori, S.; Steg, P.Gabriel.; Wijns, W.; Smits, P.C.; Jeger, R.V.; Leon, M.B.; Windecker, S.; Serruys, P.W.; Morice, M-Claude.; Camenzind, E.; Weisz, G.; Kandzari, D.; Dangas, G.D.; Mastoris, I.; Von Birgelen, C.; Galatius, S.; Kimura, T.; Mikhail, G.; Itchhaporia, D.; Mehta, L.; Ortega, R.; Kim, H-Soo.; Valgimigli, M.; Kastrati, A.; Chieffo, A.; Mehran, R.
American Journal of Cardiology 116(6): 845-852
ISSN/ISBN: 0002-9149 PMID: 26174605 DOI: 10.1016/j.amjcard.2015.06.010
The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.