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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

Authors
 Fadi J. Sawaya  ;  Marie-Claude Morice  ;  Marco Spaziano  ;  Roxana Mehran  ;  Romain Didier  ;  Andrew Roy  ;  Marco Valgimigli  ;  Hyo-Soo Kim  ;  Kyung Woo Park  ;  Myeong-Ki Hong  ;  Byeong-Keuk Kim  ;  Yangsoo Jang  ;  Fausto Feres  ;  Alexandre Abizaid  ;  Ricardo A. Costa  ;  Antonio Colombo  ;  Alaide Chieffo  ;  Gennaro Giustino  ;  Gregg W. Stone  ;  Deepak L. Bhatt  ;  Tullio Palmerini  ;  Martine Gilard 
Citation
 CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol.89(2) : 178-189, 2017 
Journal Title
 CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS 
ISSN
 1522-1946 
Issue Date
2017
MeSH
Aged ; Coronary Thrombosis/etiology ; Drug Administration Schedule ; Drug-Eluting Stents* ; Female ; Hemorrhage/chemically induced ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/etiology ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/instrumentation* ; Percutaneous Coronary Intervention/mortality ; Platelet Aggregation Inhibitors/administration & dosage* ; Platelet Aggregation Inhibitors/adverse effects ; Proportional Hazards Models ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors ; Sex Factors ; Time Factors ; Treatment Outcome
Keywords
drug-eluting stents ; dual antiplatelet therapy duration ; major adverse cardiac events ; women
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- (≤6 months) versus long-term (≥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 0.62-1.25) and men (HR 1.25; 95% CI 0.95-1.6; 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 0.51-1.37) and men (HR 0.58; 95% CI 0.40-0.84; P-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 0.60-2.23) and men (HR: 2.29; CI 1.22-4.29; 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.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/ccd.26653/abstract
DOI
10.1002/ccd.26653
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154489
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