Title of article :
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)
Author/Authors :
Lansky، نويسنده , , Alexandra J. and Mehran، نويسنده , , Roxana and Cristea، نويسنده , , Ecatarina and Parise، نويسنده , , Helen and Feit، نويسنده , , Frederick and Ohman، نويسنده , , E. Magnus and White، نويسنده , , Harvey D. and Alexander، نويسنده , , Karen P. and Bertrand، نويسنده , , Michel E. and Desmet، نويسنده , , Walter and Hamon، نويسنده , , Martial and Stone، نويسنده , , Gregg W.، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2009
Pages :
8
From page :
1196
To page :
1203
Abstract :
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 <0.0001) and net clinical outcomes (13% vs 10% p <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 <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.
Journal title :
American Journal of Cardiology
Serial Year :
2009
Journal title :
American Journal of Cardiology
Record number :
1897745
Link To Document :
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