Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study trial

• Published in: The American heart journal Vol. 163; no. 1; pp. 104 - 111
• Main Authors: Ferrante, Giuseppe, MD, PhD, Presbitero, Patrizia, MD, Corrada, Elena, MD, Campo, Gianluca, MD, Bolognese, Leonardo, MD, Vassanelli, Corrado, MD, Colangelo, Salvatore, MD, De Cesare, Nicoletta, MD, E. Rodriguez, Alfredo, MD, PhD, Bramucci, Ezio, MD, Moreno, Raul, MD, Piva, Tommaso, MD, Sheiban, Imad, MD, Pasquetto, Giampaolo, MD, Prati, Francesco, MD, Nazzaro, Marco S., MD, PhD, Ferrari, Roberto, MD, PhD, Valgimigli, Marco, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Mosby; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antibodies, Monoclonal - administration & dosage; Arrhythmias, Cardiac - complications; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diseases of the cardiovascular system; Drug-Eluting Stents; Female; Heart; Heart attacks; Humans; Immunoglobulin Fab Fragments - administration & dosage; Immunosuppressive Agents - administration & dosage; Ischemia; Italy; Kinases; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - administration & dosage; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Sex Factors; Sirolimus - administration & dosage; Studies; Thrombosis; Tyrosine - administration & dosage; Tyrosine - analogs & derivatives; Italy; Myocardial infarction; Prognosis; Sirolimus; Angioplasty; Multicenter study; Sex; Cardiovascular disease; Metal; Myocardial disease; Percutaneous route; ST elevation; Tirofiban; Primary; Cardiology; High dose; Drug eluting stent; Human; Endoprosthesis; Evaluation; Atherectomy; Abciximab; Acute; Coronary artery; Single dose; Instrumentation therapy; Patient; Coronary heart disease; Long term; Antibiotic; Circulatory system; Immunosuppressive agent; Antibacterial agent; Comparative study
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2011.09.026

Objectives We assessed the relation between female sex and sirolimus-eluting stent (SES) use on long-term outcomes in acute myocardial infarction. Background There are no data on sex-specific differences in long-term benefit of SES use compared with bare-metal stent (BMS) use among patients undergoing primary percutaneous coronary interventions. Methods We performed a post hoc analysis of the MULTISTRATEGY trial. Hazard ratios (HRs) of events with 95% CI for sex and stent type were computed using Cox proportional regression with adjustment for confounders. Results A total of 744 patients, 64 years old (55-73 years old), 179 (24.1%) women, were enrolled. After a follow-up of 1,080 days, SES use was associated with a significant reduction of major adverse cardiovascular events, that is, the composite of all-cause death, reinfarction, or clinically driven target vessel revascularization (TVR) (13.9% vs 23.6%, adjusted HR 0.62, 95% CI 0.41-0.94, P = .026) and of TVR (6.1% vs 15.1%, adjusted HR 0.35, 95% CI 0.19-0.63, P < .001) in men. Conversely, SES use was not associated to a better outcome among women (major adverse cardiovascular events 21.9% in SES vs 18.2% in the BMS group, adjusted HR 1.27, 95% CI 0.53-3.02, P = .59; TVR 6.6% vs 9.1%, adjusted HR 0.62, 95% CI 0.17-2.21, P = .46). Conclusions In this analysis, the clinical benefit of SES use, over BMS, at 3-year follow-up was restricted to men and was not observed among women.