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Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis.
Venetsanos, Dimitrios; Sederholm Lawesson, Sofia; Alfredsson, Joakim; Janzon, Magnus; Cequier, Angel; Chettibi, Mohamed; Goodman, Shaun G; Van't Hof, Arnoud W; Montalescot, Gilles; Swahn, Eva.
Afiliação
  • Venetsanos D; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
  • Sederholm Lawesson S; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
  • Alfredsson J; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
  • Janzon M; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
  • Cequier A; Heart Disease Institute, Hospital Universitario de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
  • Chettibi M; Centre Hospito-universitaire Frantz Fanon, Blida, Algeria.
  • Goodman SG; Division of Cardiology, Canadian Heart Research Centre, St Michael's Hospital, University of Toronto, Toronto, Canada.
  • Van't Hof AW; Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
  • Montalescot G; UPMC Sorbonne Universités, ACTION Study Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
  • Swahn E; Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
BMJ Open ; 7(9): e015241, 2017 Sep 21.
Article em En | MEDLINE | ID: mdl-28939567
OBJECTIVES: To evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). SETTINGS: A prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery. PARTICIPANTS: Between September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included. INTERVENTIONS: Patients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor. OUTCOMES: The main objective was to study the association between gender and primary and secondary outcomes of the main study with a focus on the clinical efficacy and safety outcomes. PRIMARY OUTCOME: the proportion of patients who did not have 70% resolution of ST-segment elevation and did not meet the criteria for Thrombolysis In Myocardial Infarction (TIMI) flow 3 at initial angiography. Secondary outcome: the composite of death, MI, stent thrombosis, stroke or urgent revascularisation and major or minor bleeding at 30 days. RESULTS: Women were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery. Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51). After adjustment, the difference was attenuated but remained statistically significant (HR 2.08, 95% CI 1.03 to 4.20). The incidence of major bleeding events was twofold to threefold higher in women compared with men. In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3-5 HR 1.45, 95% CI 0.72 to 2.91). There was no interaction between gender and efficacy or safety of randomised treatment. CONCLUSION: In patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could mainly be explained by older age and clustering of comorbidities. CLINICAL TRIAL REGISTRATION: NCT01347580;Post-results.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Adenosina / Fatores Sexuais / Antagonistas do Receptor Purinérgico P2Y / Infarto do Miocárdio com Supradesnível do Segmento ST Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Adenosina / Fatores Sexuais / Antagonistas do Receptor Purinérgico P2Y / Infarto do Miocárdio com Supradesnível do Segmento ST Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article