Sex Differences in 10-Year Outcomes Following STEMI: A Subanalysis From the EXAMINATION-EXTEND Trial

Rami Gabani, Francesco Spione, Victor Arevalos, Nadine Grima Sopesens, Luis Ortega-Paz, Josep Gomez-Lara, Victor Jimenez-Diaz, Marcelo Jimenez, Pilar Jiménez-Quevedo, Roberto Diletti, Javier Pineda, Gianluca Campo, Antonio Silvestro, Jaume Maristany, Xacobe Flores, Loreto Oyarzabal, Guillermo Bastos-Fernandez, Andrés Iñiguez, Antonio Serra, Javier EscanedAlfonso Ielasi, Maurizio Tespili, Mattie Lenzen, Nieves Gonzalo, Pascual Bordes, Matteo Tebaldi, Simone Biscaglia, Soheil Al-Shaibani, Rafael Romaguera, Joan Antoni Gomez-Hospital, Josep Rodes-Cabau, Patrick W. Serruys, Manel Sabaté, Salvatore Brugaletta*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1965-1973
Number of pages9
JournalJACC: Cardiovascular Interventions
Issue number19
Publication statusPublished - 10 Oct 2022

Bibliographical note

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


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