OCT documented similarities between men, women treated with DES

PARIS — Among men and women with STEMI, optical coherence tomography demonstrated a similar vascular response to current generation drug-eluting stents, according to results of the OCTAVIA trial presented at EuroPCR.

Perspective from William Wijns, MD, PhD, FESC

Giulio Guagliumi, MD, principal investigator of OCTAVIA, and colleagues conducted the prospective, multicenter, controlled, investigator-driven trial to determine whether gender-related differences in STEMI pathophysiology and vascular response in current-generation DES can be observed in vivo after adjusting for age. The first-of-its-kind study included 140 age-matched men and women with STEMI who underwent primary PCI with an everolimus-eluting stent (Xience Prime, Abbott Vascular).

Guagliumi, who is an interventional cardiologist at Ospedale Papa Giovanni XXIII in Bergamo, Italy, and colleagues examined the histopathology and immunohistochemistry of thrombus and serum biomarkers with serial OCT.

Giulio Guagliumi

Patients were enrolled in a 1:1 ratio depending on gender and age, which was ensured by a computer-assisted algorithm, according to Guagliumi.

“A gender difference in pathophysiology of STEMI is suggested by an autopsy series, but never systematically investigated in vivo in the context of primary PCI,” Guagliumi told Cardiology Today’s Intervention. “The patients in this study were perfectly balanced in every respect minimizing the confounding effect of age, with the exception of artery size, which was much smaller in women.”

Data indicated no significant differences in ruptured plaque (men, 50% vs. women, 48.4%; P=.56), non-ruptured plaque/erosion (men, 25% vs. women, 25%; P=.86) and spontaneous dissection (men, 0% vs. women, 3.1%; P=1).

Additionally, roughly one-quarter of the cases in both arms had an unidentifiable culprit lesion because there was too much thrombus hiding the culprit plaque, Guagliumi said. “This reinforces the need for a much better thrombus removal [device],” he said.

At 9 months, strut coverage was reported in 92.5% of men and 90.9% or women (P=.89).

As a result of the findings, Guagliumi said that the current generation of stents is working nicely in both men and women.

“If we are thinking about the differences between men and women, we should focus more on time of presentation and management rather than biological factors,” he said. “These findings [should] end some reluctance with treating women because they have smaller vessels.” – by Brian Ellis

For more information:

Guagliumi G. Hot line: Late-breaking trials and innovations. Presented at: EuroPCR; May 20-23, 2014; Paris.

Disclosure: The study was supported by the Italian Society of Invasive Cardiology and an unrestricted grant from Abbott Vascular. Guagliumi reports serving as consultant for Boston Scientific and St. Jude Medical, and receiving institutional grant/research support from Abbott Vascular, Boston Scientific and St. Jude Medical.

Perspective

William Wijns, MD, PhD, FESC

I was living with the idea that erosion was more frequent in women and this trial has clearly shown that is not the case. It also showed that erosion is more frequent than we had anticipated. We like to think that most of the acute events — unstable angina or STEMI — are triggered by fissure and plaque rupture, and Dr. Guagliumi and colleagues showed that it occurs about 25% of the time for both men and women, so it is more important than we think.

The trial also found no difference in terms of the mechanisms between genders, but we still have some of the differences that have been highlighted before in women, such as smaller vessels and the fact that women tend to come for diagnosis older than men, therefore may have more extensive plaque burden.

William Wijns, MD, PhD, FESC

EuroPCR Course Director

Chairman of PCR

Disclosures: Wijns reports financial disclosures with several device manufacturers.