Antithrombotic Management and Outcomes of Anterior ST-Elevation Myocardial Infarction With New-Onset Wall Motion
Laurie-Anne Boivin-Proulx1, Fabrice Ieroncig2, Simon-Pierre Demers3
1Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
This study found no significant differences in left ventricular thrombus prophylaxis or clinical outcomes between men and women after anterior ST-elevation myocardial infarction (STEMI) with new-onset wall motion abnormalities. Treatment rates and 6-month adverse events were similar for both sexes.
Area of Science:
- Cardiology
- Clinical Research
- Sex Differences in Medicine
Background:
- Anterior ST-elevation myocardial infarction (STEMI) can lead to antero-apical wall motion abnormalities (WMAs).
- The risk of left ventricular thrombus formation is a concern in these patients.
- Existing research has not clarified potential sex-based differences in prophylaxis and outcomes for STEMI patients with WMAs.
Purpose of the Study:
- To investigate if prophylaxis rates for left ventricular thrombus differ between men and women with anterior STEMI and new-onset antero-apical WMAs.
- To compare clinical outcomes at 6 months between men and women following anterior STEMI with WMAs.
- To assess sex-based disparities in the management and prognosis of this patient cohort.
Main Methods:
- A multicentre retrospective cohort study was performed on patients with STEMI and antero-apical WMAs treated with primary percutaneous coronary intervention.
- Patients with prior oral anticoagulation use were excluded from the analysis.
- Triple therapy rates at discharge and net adverse clinical events at 6 months were compared between sexes using multivariate logistic regression.
Main Results:
- The study included 1664 patients (24.2% women).
- Triple therapy prescription at discharge was similar between women (34.3%) and men (38.7%).
- At 6 months, net adverse clinical events occurred in 8.2% of women and 7.6% of men, with no significant difference after adjustment.
Conclusions:
- Rates of oral anticoagulation prescription for left ventricular thrombus prophylaxis were similar in women and men.
- Clinical outcomes at 6 months were comparable between sexes following anterior STEMI with new-onset antero-apical WMAs.
- No significant sex-based differences were observed in the risk of bleeding or ischemic events.
Background:
In patients with anterior ST-elevation myocardial infarction (STEMI) and new-onset antero-apical wall motion abnormalities (WMAs), whether the rate of prophylaxis against left ventricular thrombus and outcomes differ between men and women is unknown.
Methods:
A multicentre retrospective cohort study of patients with STEMI and new-onset antero-apical WMAs treated with primary percutaneous coronary intervention was conducted. Patients with an established indication of oral anticoagulation (OAC) were excluded. The rates of triple therapy (double antiplatelet therapy + OAC) at discharge were compared for women vs men. The rates of net adverse clinical events, a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 6 months were compared across sex using a multivariate logistic regression model.
Results:
A total of 1664 patients were included in the primary analysis, of whom 402 (24.2%) were women and 1262 (75.8%) were men. A total of 138 women (34.3%) and 489 men (38.7%) received a triple therapy prescription at discharge (P = 0.11). At 6 months, 33 women (8.2%) and 96 men (7.6%) experienced a net adverse clinical event (adjusted odds ratio 0.82; 95% confidence interval 0.49-1.37). No difference occurred in the risk of bleeding events and ischemic events between men and women, when these were analyzed separately.
Conclusions:
The rates of OAC prescription for left ventricular thrombus prophylaxis and clinical outcomes at 6 months were similar in women and men following anterior STEMI with new-onset antero-apical WMAs.
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