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Article
Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS Study
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
  • Jaya Chandrasekhar
  • Usman Baber
  • Samantha Sartori
  • Michela Faggioni
  • Melissa Aquino
  • Annapoorna Kini
  • William Weintraub
  • Sunil Rao
  • Samir Kapadia
  • Sandra Weiss
  • Craig Strauss
  • Catalin Toma
  • Brent Muhlestein
  • Anthony C DeFranco, Aurora Health Care
  • Mark Effron
  • Stuart Keller
  • Brian Baker
  • Stuart Pocock
  • Timothy Henry
  • Roxana Mehran
Aurora Affiliations

Aurora Cardiovascular Services

Publication Date
3-1-2017
Abstract

BACKGROUND: Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under-treatment. We sought to compare the 1-year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort.

METHODS: PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression.

RESULTS: The study cohort included 4851 patients of which 1162 (24.0%) were women and 3689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one-third of patients (31.8% in men vs. 28.1% in women, p = 0.01). Unadjusted, 1-year MACE (21.1% vs. 16.2%, p < 0.001) and bleeding (3.6% vs. 2.2%, p = 0.01) was significantly higher in women compared with men, but these results were no longer significant after adjustment for risk (HR 1.13, 95% CI 0.94-1.36 for MACE and HR 1.31, 95% CI 0.85-2.04 for bleeding).

CONCLUSION: Women younger than 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1-year MACE and bleeding than men, findings that are attributable to baseline differences. This article is protected by copyright. All rights reserved.

Document Type
Article
PubMed ID
27152497
DOI
10.1002/ccd.26606
Citation Information

Chandrasekhar J, Baber U, Sartori S, et al. Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS Study. Catheter Cardiovasc Interv. 2017;89(4):629-637; doi: 10.1002/ccd.26606