Impact of Gender and Antithrombin Strategy on Early and Late Clinical Outcomes in Patients With Non–ST-Elevation Acute Coronary Syndromes (from the ACUITY Trial)

Women with non–ST-elevation acute coronary syndrome are at increased risk for ischemic and bleeding complications compared with men. We examined the impact of gender and antithrombotic therapy for non–ST-elevation acute coronary syndrome on outcomes in patients in the ACUITY trial. Patients were ran...

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Bibliographic Details
Published in:The American journal of cardiology 2009-05, Vol.103 (9), p.1196-1203
Main Authors: Lansky, Alexandra J., MD, Mehran, Roxana, MD, Cristea, Ecatarina, MD, Parise, Helen, ScD, Feit, Frederick, MD, Ohman, E. Magnus, MD, White, Harvey D., MD, Alexander, Karen P., MD, Bertrand, Michel E., MD, Desmet, Walter, MD, Hamon, Martial, MD, Stone, Gregg W., MD
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - drug therapy
Acute Coronary Syndrome - mortality
Acute Coronary Syndrome - therapy
Acute coronary syndromes
Adult
Age Factors
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary - methods
Angioplasty, Balloon, Coronary - mortality
Anticoagulants - therapeutic use
Antithrombins - therapeutic use
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Cause of Death
Clinical outcomes
Coronary heart disease
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Electrocardiography
Enoxaparin - therapeutic use
Female
Follow-Up Studies
Gender
Heart
Heparin - therapeutic use
Hirudins
Humans
Male
Medical research
Medical sciences
Middle Aged
Myocarditis. Cardiomyopathies
Patients
Peptide Fragments - therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex - therapeutic use
Probability
Proportional Hazards Models
Recombinant Proteins - therapeutic use
Reference Values
Risk Assessment
Severity of Illness Index
Sex Factors
Survival Analysis
Time Factors
Treatment Outcome
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Description
Summary:Women with non–ST-elevation acute coronary syndrome are at increased risk for ischemic and bleeding complications compared with men. We examined the impact of gender and antithrombotic therapy for non–ST-elevation acute coronary syndrome on outcomes in patients in the ACUITY trial. Patients were randomized to heparin (unfractionated or enoxaparin) plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin alone. We compared major bleeding unconnected to coronary artery bypass grafting, composite ischemia (death, myocardial infarction, or revascularization), and net clinical outcome (composite ischemia or bleeding) in (1) men versus women overall and undergoing percutaneous coronary intervention (PCI) and (2) women overall and undergoing PCI by antithrombotic strategy. Of 13,819 patients enrolled, 4,157 were women (30.1%). Women had similar 30-day composite ischemia (7% vs 8%, p = 0.07) but greater 30-day rates of major bleeding (8% vs 3% p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2009.01.030