NEW YORK (Reuters Health) – Men and women had similar clinical and angiographic outcomes after coronary revascularization with drug-eluting stents (DES) in a recent study.
The research team was not surprised. “Based on our routine clinical experience we expected drug-eluting stents to perform similarly in women and men with respect to angiographic outcomes, as well as long-term clinical safety and efficacy,” Dr. Stephan Windecker from Bern University Hospital, Bern, Switzerland told Reuters Health in an email.
As reported in the March issue of JACC: Cardiovascular Interventions, Dr. Windecker and colleagues analyzed data on 1,164 women and 3,721 men who participated in the SIRTAX, LEADERS, or RESOLUTE All-Comers randomized trials.
At two years of follow-up after coronary revascularization with DES, there was no gender difference in the combined risk of cardiac death or myocardial infarction (8.3% in women vs 6.6% in men), or in the risk of cardiac death (2.9% vs 2.5%), myocardial infarction (5.8% vs 4.7%), repeat intervention (6.1% vs 6.0%), target vessel revascularization (6.4% vs 7.5%), or stent thrombosis (1.7% for both).
As for angiographic outcomes, women and men did not differ in mean in-stent late lumen loss (0.18 vs 0.20 mm) or in rates of in-segment binary restenosis (8.5% for both).
Women undergoing coronary revascularization were older, had more cardiovascular risk factors (except for smoking), and had a lower degree of angiographic complexity than men undergoing coronary revascularization. Results were adjusted for these differences.
“Whether women with coronary artery disease receive a similar standard of treatment as men is still a matter of some debate,” Dr. Windecker said. “This could also be somewhat speculated based on our findings, since we observed that women are scheduled for PCI (percutaneous coronary intervention) at a later stage and with a more complex baseline risk profile as compared to men.”
An editorial by Dr. Cindy L. Grines and Dr. Theodore Schreiber from Wayne State University School of Medicine, Detroit, Michigan says, “Results of (this) study and others suggest that DES have leveled the playing field between men and women undergoing PCI.”
But, the editorial concludes. “Although it is an incredible success that both women and men can now undergo PCI with similar benefits, elucidation of differences in the prevalence, mechanism, manifestation, and treatment of cardiovascular disease will require more sex-specific investigations.”
Dr. Windecker added, “We are currently planning to investigate whether outcomes of women and men treated with drug-eluting stents are also similar among higher-risk populations. In this regard, we will present some interesting findings on sex-based difference among patients with acute coronary syndromes at EuroPCR 2012 next May in Paris.”
J Am Coll Cardiol Intv 2012;5:301-310,311-312.