Sex Differences in 10-Year Outcomes Following STEMI: A Subanalysis From the EXAMINATION-EXTEND Trial

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Short-term outcomes post-ST-segment elevation myocardial infarction (STEMI) are worse in women than men.
• The role of sex in very long-term STEMI outcomes remains unclear.

Purpose of the Study:

• To investigate sex differences in very long-term outcomes following STEMI treatment.
• To assess the 10-year patient-oriented composite endpoint in men versus women post-STEMI.

Main Methods:

• Subanalysis of the EXAMINATION-EXTEND trial, a 10-year follow-up of STEMI patients treated with everolimus-eluting stents or bare-metal stents.
• Primary endpoint: composite of all-cause death, myocardial infarction, or revascularization at 10 years, adjusted for age.
• Secondary endpoints: individual components of the primary endpoint.

Main Results:

• Women (17%) were older, with more hypertension and less smoking history than men.
• No significant difference in the 10-year patient-oriented composite endpoint between women and men (40.6% vs 34.2%).
• A trend towards higher all-cause death in women (27.6% vs 19.4%), not driven by cardiac death.

Conclusions:

• Very long-term outcomes post-STEMI are similar between sexes regarding the composite endpoint.
• A trend of increased all-cause mortality in women warrants further investigation and personalized treatment strategies.
• Personalized medicine for women post-percutaneous revascularization should address cardiovascular and sex-specific risk factors.