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)

被引：61

作者：

Lansky, Alexandra J. ^{[1
,2
]}

Mehran, Roxana ^{[1
,2
]}

Cristea, Ecatarina ^{[1
,2
]}

Parise, Helen ^{[1
,2
]}

Feit, Frederick ^{[3
]}

Ohman, E. Magnus ^{[4
]}

White, Harvey D. ^{[5
]}

Alexander, Karen P. ^{[4
]}

Bertrand, Michel E. ^{[6
]}

Desmet, Walter ^{[8
]}

Hamon, Martial ^{[7
]}

Stone, Gregg W. ^{[1
,2
]}

机构：

[1] Columbia Univ, Med Ctr, New York, NY 10027 USA

[2] Cardiovasc Res Fdn, New York, NY USA

[3] NYU, Sch Med, New York, NY USA

[4] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA

[5] Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand

[6] Hop Cardiol, F-59037 Lille, France

[7] Univ Hosp, Normandy, France

[8] Univ Hosp Gasthuisberg, B-3000 Louvain, Belgium

来源：

AMERICAN JOURNAL OF CARDIOLOGY | 2009年 / 103卷 / 09期

关键词：

GLYCOPROTEIN IIB/IIIA INHIBITORS; PREDICTORS; WOMEN; MEN; COMPLICATIONS; INTERVENTION; ABCIXIMAB; MORTALITY; EVENTS; RISK;

D O I：

10.1016/j.amjcard.2009.01.030

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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 (unfiractionated 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% p <0.0001) and net clinical outcomes (13% vs 10% p <0.0001) 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%, p <0.0001) 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. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;103:1196-1203)

引用

页码：1196 / 1203

页数：8

共 30 条

[1]

Sex differences in major bleeding with glycoprotein IIb/IIIa inhibitors - Results from the CRUSADE (can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines) initiative [J].

Alexander, Karen P. ;

Chen, Anita Y. ;

Newby, L. Kristin ;

Schwartz, Janice B. ;

Redberg, Rita F. ;

Hochman, Judith S. ;

Roe, Matthew T. ;

Gibler, W. Brian ;

Ohman, E. Magnus ;

Peterson, Eric D. .

CIRCULATION, 2006, 114 (13) :1380-1387

[2]

Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes [J].

Alexander, KP ;

Chen, AY ;

Roe, MT ;

Newby, LK ;

Gibson, CM ;

Allen-LaPointe, NM ;

Pollack, C ;

Gibler, WB ;

Ohman, EM ;

Peterson, ED .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 294 (24) :3108-3116

[3]

Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes:: a meta-analysis of all major randomised clinical trials [J].

Boersma, E ;

Harrington, RA ;

Moliterno, DJ ;

White, H ;

Théroux, P ;

Van de Werf, F ;

de Torbal, A ;

Armstrong, PW ;

Wallentin, LC ;

Wilcox, RG ;

Simes, J ;

Califf, RM ;

Topol, EJ ;

Simoons, ML .

LANCET, 2002, 359 (9302) :189-198

[4]

Chacko M, 2006, AM HEART J, V151, DOI 10.1016/j.ahj.2006.02.012

[5]

Predictors of bleeding complications after rescue coronary interventions [J].

Dauerman, HL ;

Andreou, C ;

Perras, MA ;

Spinner, JS ;

Lessard, D ;

Weiner, BH .

JOURNAL OF THROMBOSIS AND THROMBOLYSIS, 2000, 10 (01) :83-88

[6]

Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without St elevation: a meta-analysis [J].

Eikelboom, JW ;

Anand, SS ;

Malmberg, K ;

Weitz, JI ;

Ginsberg, JS ;

Yusuf, S .

LANCET, 2000, 355 (9219) :1936-1942

[7]

Acute coronary syndrome - The risk of being female [J].

Elsaesser, A ;

Hamm, CW .

CIRCULATION, 2004, 109 (05) :565-567

[8]

Predictors and impact of major Hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2 trial [J].

Feit, Frederick ;

Voeltz, Michele D. ;

Attubato, Michael J. ;

Lincoff, A. Michael ;

Chew, Derek P. ;

Bittl, John A. ;

Topol, Eric J. ;

Manoukian, Steven V. .

AMERICAN JOURNAL OF CARDIOLOGY, 2007, 100 (09) :1364-1369

[9]

Is glycoprotein IIb/IIIa antagonism as effective in women as in men following percutaneous coronary intervention? Lessons from the ESPRIT study [J].

Fernandes, LS ;

Tcheng, JE ;

O'Shea, JC ;

Weiner, B ;

Lorenz, TJ ;

Pacchiana, C ;

Berdan, LG ;

Maresh, KJ ;

Joseph, D ;

Madan, M ;

Mann, T ;

Kilaru, R ;

Hochman, JS ;

Kleiman, NS .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (06) :1085-1091

[10]

Gender differences in clinical outcome after coronary artery stenting with use of glycoprotein IIb/IIIa inhibitors [J].

Iakovou, L ;

Dangas, G ;

Mehran, R ;

Lansky, AJ ;

Kobayashi, Y ;

Adamian, M ;

Polena, S ;

Collins, MB ;

Roubin, GS ;

Stone, GW ;

Leon, MB ;

Moses, JW .

AMERICAN JOURNAL OF CARDIOLOGY, 2002, 89 (08) :976-+

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