Long-term outcomes similar between men, women after STEMI
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After STEMI treated with primary PCI, men and women were equally likely to experience any MI, any revascularization or die of any cause during 10 years of follow-up, data from a retrospective analysis show.
“At 10 years follow-up after a STEMI, we did not find any difference in terms of a combined patient-oriented endpoint between women and men, with a trend towards a higher all-cause death in women vs. men which was not driven by cardiac death,” Salvatore Brugaletta MD, PhD, a consultant in interventional cardiology at Hospital Clinic in Barcelona, Spain, told Healio. “We also observed a higher rate of repeat revascularization in men vs. women within the first 5-year follow-up, but not thereafter.”
Long-term STEMI data
Brugaletta and colleagues analyzed sex-stratified data from 1,498 adults with STEMI assigned to receive an everolimus-eluting stent (Xience V, Abbott Vascular) or bare-metal stent (Multilink Vision, Abbott Vascular), including 254 women on average 8 years older than men, all participating in EXAMINATION-EXTEND, a 10-year follow-up of the EXAMINATION study. The primary endpoint was a composite of all-cause death, any MI or any revascularization at 10 years. Secondary endpoints were individual components of the primary endpoint; with all endpoints adjusted for age.
The findings were published in JACC: Cardiovascular Interventions and presented at the European Society of Cardiology Congress.
At 10 years, researchers observed no difference between women and men for the composite endpoint (women, 40.6%; men, 34.2%; adjusted HR = 1.14; 95% CI, 0.91-1.42; P = .259). Compared with men, researchers observed a trend toward higher all-cause death among women (women, 27.6%; men, 19.4%; aHR = 1.3; 95% CI, 0.99-1.71; P = .063), with no between-group differences in cardiac death (aHR = 1.19; 95% CI, 0.82-1.72; P = .356) or other endpoints.
“Our findings may have important clinical implications for developing more focused, personalized medicine for women after STEMI, aimed not only at controlling CV risk factors but also at preventing all-cause death that is not explained by a cardiac cause,” Brugaletta told Healio. “Our findings should be confirmed in other studies with longer-term follow-up. The next step should be to analyze the cause of all-cause death in women in order to understand ideal treatments.”
‘Inequalities and opportunities do exist’
In a related editorial, Stefano Savonitto, MD, of the division of cardiology at Ospedale Alessandro Manzoni in, Lecco, Italy, and Nuccia Morici, MD, PhD, of the cardio-respiratory department at IRCCS Fondazione Don Carlo Gnocchi in Milan, Italy, noted that, in the adjusted model for the primary composite outcome of the study, 1 year of difference in age accounted for a 6% increase in 10-year risk (HR = 1.06, 95% CI 1.04-1.09; P < .001).
“In numerical terms, 8 years of difference in age would account for a 48% increase in risk, whereas the unadjusted difference observed was actually lower: 40.6% in women vs. 34.2% in men,” Savonitto and Morici wrote. “These figures, well discussed in the paper by Gabani et al, show the difficulty of drawing pathophysiological and epidemiological conclusions about gender-related differences outside the setting of age- and sex-balanced prospective studies.”
Savonitto and Morici wrote that that researchers have worked to recognize similar pathogenetic mechanisms and provide equal care to women and men; however, “inequalities and opportunities do exist to improve quality of care.
“As underlined in recent consensus documents, most of these opportunities lie in improvements in dietary habits, overweight and physical inactivity, rather than in drugs and the catheterization laboratory,” Savonitto and Morici wrote.
References:
- Gabani R, et al. JACC Cardiovasc Interv. 2022;doi:10.1016/j.jcin.2022.07.038.
- Savonitto S, et al. JACC Cardiovasc Interv. 2022;doi:10.1016/j.jcin.2022.07.047.
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Gabani R, et al. All about coronary artery disease. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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