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Women undergoing PCI with newer DES have higher prevalence of chest pain
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In a pooled analysis of the DUTCH PEERS and TWENTE randomized trials, the prevalence of clinically relevant chest pain was significantly higher among women undergoing PCI with newer-generation drug-eluting stents compared with men.
The patient-level pooled analysis included 3,202 patients with stable or acute ACS who were treated with newer-generation permanent polymer-coated DES. In DUTCH PEERS, patients were randomly treated with the Resolute zotarolimus-eluting stent (Medtronic Vascular) or the Xience V everolimus-eluting stent (Abbott Vascular). In DUTCH PEERS, patients were randomly treated with the Resolute Integrity zotarolimus-eluting stent (Medtronic Vascular) or the Promus Element everolimus-eluting stent (Boston Scientific).
Twenty-seven percent of the pooled patients were women. Compared with men, the women were older (mean age, 67.5 years vs. 62.8 years) and had more CV risk factors including diabetes (24.2% vs. 17.8%), hypertension (63.6% vs. 51.6%) and a positive family history (54.5% vs. 50.1%).
Researchers analyzed data on clinical follow-up data and patient-reported chest pain at 1 and 2 years based on outpatient visits or telephone/medical questionnaires conducted as part of the two trials. Clinical follow-up data were available for 99.8% of patients and chest pain data for 94.1% of patients at 1 year and 93.6% of patients at 2 years.
At 1 year, clinically relevant patient-reported chest pain was more common among women compared with men (16.3% vs. 10.5%; P < .001). The researchers observed a similar trend at 2-year follow-up (women, 17.2% vs. men, 11.1%; P < .001). According to multivariate analysis, female gender was an independent predictor of clinically relevant chest pain at follow-up. At 2 years, risk for chest pain among women was increased 1.8-fold during normal daily activities and 1.7-fold at rest, according to the findings.
Rates of mortality, MI, revascularization, stent thrombosis and composite endpoints were similar between women and men at 2 years.
“While the incidence of adverse cardiovascular events was low and similar for both genders after PCI with newer-generation DES, women showed a significantly higher prevalence of clinically relevant chest pain that might be largely related to mechanisms other than the obstruction of epicardial coronary arteries,” the researchers concluded. – by Jennifer Byrne
Disclosure: Several researchers report financial relationships with device and pharmaceutical companies. Please see the full study for a list of the authors’ relevant financial disclosures.
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