Background: Whether the efficacy and safety of dual antiplatelet therapy (DAPT) are uniform between sexes is unclear. We sought to compare clinical outcomes between short- (â ¤6 months) versus long-term (â ¥1 year) DAPT after drug-eluting stent (DES) placement in women and men. Methods and Results: We pooled individual patient data from 6 randomized trials of DAPT (EXCELLENT, OPTIMIZE, PRODIGY, RESET, SECURITY, ITALIC PLUS). The primary outcome was 1-year risk of major adverse cardiac events (MACE). The main secondary outcome was 1-year risk of any bleeding. Out of the 11,473 randomized patients included in the pooled dataset, 3,454 (30%) were females. At 1-year follow-up, women had higher risk of MACE (3.6% vs. 2.8%; P = 0.01) but similar risk of bleeding (1.9% vs. 1.6%; P = 0.16) as compared with men. Compared with long-term DAPT, short-term DAPT was associated with similar rates of MACE in both women (HR 0.88; 95% CI 0.62â 1.25) and men (HR 1.25; 95% CI 0.95â 1.6; P interaction = 0.08)]. At 1-year follow-up, short-term DAPT was associated with lower rates of bleeding as compared with long-term DAPT in both women (HR 0.84; 95% CI 0.51â 1.37) and men (HR 0.58; 95% CI 0.40â 0.84; Pâ interaction = 0.25). The presence of MVD was associated with higher MACE rates in the short-term DAPT group in women (HR: 1.16; CI 0.60â 2.23) and men (HR: 2.29; CI 1.22â 4.29; P interaction = 0.25). Conclusions: Short-term DAPT is associated with similar rates of MACE but lower risk of bleeding when as compared with prolonged DAPT. There was no significant difference between sexes in the population studied. © 2016 Wiley Periodicals, Inc.

Short-versus long-term Dual Antiplatelet therapy after drug-eluting stent implantation in women versus men: A sex-specific patient-level pooled-analysis of six randomized trials

COLOMBO, ANTONIO;
2017-01-01

Abstract

Background: Whether the efficacy and safety of dual antiplatelet therapy (DAPT) are uniform between sexes is unclear. We sought to compare clinical outcomes between short- (â ¤6 months) versus long-term (â ¥1 year) DAPT after drug-eluting stent (DES) placement in women and men. Methods and Results: We pooled individual patient data from 6 randomized trials of DAPT (EXCELLENT, OPTIMIZE, PRODIGY, RESET, SECURITY, ITALIC PLUS). The primary outcome was 1-year risk of major adverse cardiac events (MACE). The main secondary outcome was 1-year risk of any bleeding. Out of the 11,473 randomized patients included in the pooled dataset, 3,454 (30%) were females. At 1-year follow-up, women had higher risk of MACE (3.6% vs. 2.8%; P = 0.01) but similar risk of bleeding (1.9% vs. 1.6%; P = 0.16) as compared with men. Compared with long-term DAPT, short-term DAPT was associated with similar rates of MACE in both women (HR 0.88; 95% CI 0.62â 1.25) and men (HR 1.25; 95% CI 0.95â 1.6; P interaction = 0.08)]. At 1-year follow-up, short-term DAPT was associated with lower rates of bleeding as compared with long-term DAPT in both women (HR 0.84; 95% CI 0.51â 1.37) and men (HR 0.58; 95% CI 0.40â 0.84; Pâ interaction = 0.25). The presence of MVD was associated with higher MACE rates in the short-term DAPT group in women (HR: 1.16; CI 0.60â 2.23) and men (HR: 2.29; CI 1.22â 4.29; P interaction = 0.25). Conclusions: Short-term DAPT is associated with similar rates of MACE but lower risk of bleeding when as compared with prolonged DAPT. There was no significant difference between sexes in the population studied. © 2016 Wiley Periodicals, Inc.
2017
drug-eluting stents
dual antiplatelet therapy duration
major adverse cardiac events
women
Aged
Coronary Thrombosis
Drug Administration Schedule
Female
Hemorrhage
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Proportional Hazards Models
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
Drug-Eluting Stents
Radiology
Nuclear Medicine and Imaging
Cardiology and Cardiovascular Medicine
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/74947
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