TY - JOUR
T1 - Sex Differences in 10-Year Outcomes Following STEMI
T2 - A Subanalysis From the EXAMINATION-EXTEND Trial
AU - Gabani, Rami
AU - Spione, Francesco
AU - Arevalos, Victor
AU - Grima Sopesens, Nadine
AU - Ortega-Paz, Luis
AU - Gomez-Lara, Josep
AU - Jimenez-Diaz, Victor
AU - Jimenez, Marcelo
AU - Jiménez-Quevedo, Pilar
AU - Diletti, Roberto
AU - Pineda, Javier
AU - Campo, Gianluca
AU - Silvestro, Antonio
AU - Maristany, Jaume
AU - Flores, Xacobe
AU - Oyarzabal, Loreto
AU - Bastos-Fernandez, Guillermo
AU - Iñiguez, Andrés
AU - Serra, Antonio
AU - Escaned, Javier
AU - Ielasi, Alfonso
AU - Tespili, Maurizio
AU - Lenzen, Mattie
AU - Gonzalo, Nieves
AU - Bordes, Pascual
AU - Tebaldi, Matteo
AU - Biscaglia, Simone
AU - Al-Shaibani, Soheil
AU - Romaguera, Rafael
AU - Gomez-Hospital, Joan Antoni
AU - Rodes-Cabau, Josep
AU - Serruys, Patrick W.
AU - Sabaté, Manel
AU - Brugaletta, Salvatore
N1 - Funding Information:
This study was an investigator-driven clinical trial conducted by the Hospital Clinic of Barcelona. The EXAMINATION-EXTEND study was funded by an unrestricted grant from Abbott Vascular to the Spanish Heart Foundation (promoter). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright: © 2022 American College of Cardiology Foundation
PY - 2022/10/10
Y1 - 2022/10/10
N2 - Background: Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether sex plays a role in very long term outcomes. Objectives: The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by sex. Methods: EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to sex. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age. Results: Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints. Conclusions: At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and sex-specific risk factor control and targeted treatment.
AB - Background: Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether sex plays a role in very long term outcomes. Objectives: The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by sex. Methods: EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to sex. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age. Results: Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints. Conclusions: At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and sex-specific risk factor control and targeted treatment.
UR - http://www.scopus.com/inward/record.url?scp=85138425716&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2022.07.038
DO - 10.1016/j.jcin.2022.07.038
M3 - Article
C2 - 36008267
AN - SCOPUS:85138425716
SN - 1936-8798
VL - 15
SP - 1965
EP - 1973
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 19
ER -