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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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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cited_by cdi_FETCH-LOGICAL-c475t-922ec7ad9d262affaa8620e8b48072ca9724bb12e122286ba3e59d7aa85af6913
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container_title The American journal of cardiology
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creator 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
description 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
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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 &lt;0.0001) and net clinical outcomes (13% vs 10% p &lt;0.0001) than men. One-year composite ischemia and mortality was similar. In women, bivalirudin compared with heparin + GPI resulted in less 30-day major bleeding (5% vs 10%, p &lt;0.0001) but similar composite ischemia (7% vs 6%, p = 0.15). No differences were observed in rates of 1-year composite ischemia or mortality in women who received bivalirudin versus heparin + GPI. 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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</subject><ispartof>The American journal of cardiology, 2009-05, Vol.103 (9), p.1196-1203</ispartof><rights>Elsevier Inc.</rights><rights>2009 Elsevier Inc.</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. 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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 &lt;0.0001) and net clinical outcomes (13% vs 10% p &lt;0.0001) than men. One-year composite ischemia and mortality was similar. In women, bivalirudin compared with heparin + GPI resulted in less 30-day major bleeding (5% vs 10%, p &lt;0.0001) but similar composite ischemia (7% vs 6%, p = 0.15). No differences were observed in rates of 1-year composite ischemia or mortality in women who received bivalirudin versus heparin + GPI. Results were similar in women undergoing PCI. In conclusion, women had similar 30-day mortality and composite ischemia but higher net clinical adverse events due to more bleeding complications than men; 1-year mortality was similar for men and women. In women, bivalirudin monotherapy compared with a GPI-based strategy resulted in significantly decreased bleeding but similar rates of 1-year composite ischemia and mortality.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>19406258</pmid><doi>10.1016/j.amjcard.2009.01.030</doi><tpages>8</tpages></addata></record>
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identifier ISSN: 0002-9149
ispartof The American journal of cardiology, 2009-05, Vol.103 (9), p.1196-1203
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1879-1913
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source ScienceDirect Freedom Collection
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
title 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)
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