Sex-stratified differences in early antithrombotic treatment response in patients presenting with ST-segment elevation myocardial infarction

Ronak Delewi, Rosanne F. Vogel, Jeroen M. Wilschut, Miguel E. Lemmert, Roberto Diletti, Ria van Vliet, Nancy W.P.L. van der Waarden, Rutger Jan Nuis, Valeria Paradies, Dimitrios Alexopoulos, Felix Zijlstra, Gilles Montalescot, Dominick J. Angiolillo, Mitchell W. Krucoff, Pieter A. Doevendans, Nicolas M. Van Mieghem, Pieter C. Smits, Georgios J. Vlachojannis*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
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Background: The mechanisms underlying the increased risk of bleeding that female patients with ST-segment Elevation Myocardial Infarction (STEMI) exhibit, remains unclear. The present report assessed sex-related differences in response to pre-hospital dual antiplatelet therapy (DAPT) initiation in patients with STEMI. Methods: The COMPARE CRUSH trial randomized patients presenting with STEMI to receive a pre-hospital loading dose of crushed or integral prasugrel tablets in the ambulance. In this substudy, we compared platelet reactivity levels and the occurrence of high platelet reactivity (HPR; defined as platelet reactivity ≥208) between sexes at 4 prespecified time points after DAPT initiation, and evaluated post-PCI bleeding between groups. Results: Out of 633 STEMI patients, 147 (23%) were female. Females compared with males presented with significantly higher levels of platelet reactivity and higher HPR rates at baseline (232 [IQR, 209-256] vs 195 [IQR, 171-220], P < .01, and 76% vs 41%, OR 4.58 [95%CI, 2.52-8.32], P < .01, respectively). Moreover, female sex was identified as the sole independent predictor of HPR at baseline (OR 5.67 [95%CI, 2.56-12.53], P < .01). Following DAPT initiation, levels of platelet reactivity and the incidence of HPR were similar between sexes. Post-PCI bleeding occurred more frequently in females compared with males (10% vs 2%, OR 6.02 [95%CI, 2.61-11.87], P < .01). Female sex was an independent predictor of post-PCI bleeding (OR 3.25 [95%CI, 1.09-9.72], P = .04). Conclusions: In this contemporary STEMI cohort, female STEMI patients remain at risk of bleeding complications after primary PCI. However, this is not explained by sex-specific differences in the pharmacodynamic response to pre-hospital DAPT initiation.

Original languageEnglish
Pages (from-to)17-26
Number of pages10
JournalAmerican Heart Journal
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
The COMPARE CRUSH trial was supported by Maasstad research B.V. (Rotterdam, the Netherlands ) , which received unrestricted grants from Daiichi-Sankyo [Grant number: 039-20170327-EFI ] and Shanghai MicroPort Medical [Grant number: MPSH20170801148570110945 ]. The funding companies were not involved in the conduct of the trial, the analysis of the data, or the drafts of the manuscripts.

Publisher Copyright:
© 2022 The Author(s)


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