Sex-specific differences in antithrombotic therapy and prognosis in patients with acute coronary syndrome treated
Javier Jimeno-Sánchez1, Georgina Fuertes-Ferre1, Alejandra Ruiz-Aranjuelo1
1Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, España.
Insights
In acute coronary syndrome (ACS) patients treated with P2Y12 inhibitors, clopidogrel was more common in women, while ticagrelor was preferred in men. Outcomes showed similar clinical events, but women trended towards lower mortality and higher bleeding rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Sex-related differences in acute coronary syndrome (ACS) patient outcomes after percutaneous coronary intervention (PCI) with novel P2Y12 inhibitors are not well-defined.
- Understanding gender-based variations in dual antiplatelet therapy (DAPT) is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate gender-based differences in DAPT prescription patterns among ACS patients undergoing PCI.
- To analyze sex-related variations in adverse cardiovascular events and bleeding complications following PCI.
Main Methods:
- A prospective, observational study included consecutive ACS patients treated with stenting.
- Data were collected from July 2016 to January 2016, with a 1-year follow-up period.
- Patient demographics, treatment choices (including stent type and P2Y12 inhibitor), and clinical outcomes (ischemic and bleeding events) were analyzed.
Main Results:
- The study analyzed 283 patients (26.5% women). Women were older and had a higher bleeding risk (CRUSADE score) but similar ischemic risk (GRACE, TIMI scores) compared to men.
- Drug-eluting stents were more frequently used in women (88.9% vs. 75.5%). Clopidogrel was more commonly prescribed to women (42.6% vs. 50.9% for ticagrelor in men).
- After 1 year, no significant differences in major adverse cardiovascular events were observed. However, women showed a trend towards lower mortality (1.4% vs. 6.7%) and higher bleeding rates (23.3% vs. 17.4%).
Conclusions:
- In ACS patients undergoing PCI, treatment patterns with P2Y12 inhibitors differed by gender, with clopidogrel favored in women and ticagrelor in men.
- Despite differing drug choices and higher bleeding risk in women, overall clinical outcomes and ischemic event rates were similar between genders at 1-year follow-up.
- Women demonstrated a trend towards reduced mortality but increased bleeding events, highlighting the need for personalized risk-benefit assessments in DAPT selection for ACS patients.
Aims And Objective:
Impact of sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterised. We aimed to analyse gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events and bleeding.
Materials And Methods:
Prospective-observational study of the consecutive ACS patients treated with stent from July 2016 to January 2016, with a follow-up of 1 year.
Results:
We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 ± 13 vs. 66,5 ± 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischaemic risk (GRACE and TIMI). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favour of clopidogrel. No differences were observed in prasugrel prescription. No significant differences were observed after a year of follow up, but women had a tendency towards lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27).
Conclusions:
In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency towards less mortality and more bleeding events.
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