Improved two-year outcomes after drug-eluting versus bare-metal stent implantation in women and men with large coronary arteries: Importance of vessel size

• Published in: International journal of cardiology 2013-10, Vol.169 (1), p.29-34
• Main Authors: Hansen, K.W, Kaiser, C, Hvelplund, A, Soerensen, R, Madsen, J.K, Jensen, J.S, Pedersen, S.H, Eberli, F.R, Erne, P, Alber, H, Pfisterer, M, Galatius, S
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary artery disease; Coronary heart disease; Coronary Vessels - pathology; Coronary Vessels - surgery; Drug-Eluting Stents; Female; Follow-Up Studies; Gender; Heart; Humans; Male; Medical sciences; Metals - administration & dosage; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Sex Characteristics; Stents; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.08.091

Abstract Objectives To investigate the importance of vessel size on outcome differences by comparing the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) in women and men with large coronary vessels. Methods All 2314 BASKET–PROVE patients randomized to DES versus BMS were followed for 2 years with a primary endpoint of major adverse cardiac events (MACE: cardiac death, non-fatal myocardial infarction, target-vessel revascularization). Cox proportional hazard models were used to evaluate the relative risk for women and men, respectively. All comparisons were adjusted for vessel size. Results Age, risk factors and complexity of coronary artery disease differed between women and men. DES reduced MACE rates at 2 years compared to BMS — in women: 4% vs. 15%, p < 0.0001 with a hazard ratio (HR) of 0.27 (0.15–0.51), and men: 6% vs. 10%, p = 0.003 (HR = 0.60 (0.43–0.84)), respectively. The association persisted in both women (HR = 0.25 (0.13–0.46)) and men (HR = 0.60 (0.42–0.84)) following multivariable adjustments. A significant gender–treatment interaction was present (p = 0.02). The reduced risk of MACE following DES vs. BMS implantation was present until 6 months in both women (HR = 0.15 (0.06–0.36)) and men (HR = 0.32 (0.17–0.59)) and remained significant until 2 years in women (HR = 0.36 (0.15–0.87)), but not in men (HR = 0.87 (0.49–1.55)). Conclusions In women and men with similarly sized large coronary arteries, DES reduced 2-year MACE rates compared to BMS, but the significant gender–treatment interaction indicated a greater benefit of DES in women. Thus, factors other than vessel size seem to determine this gender difference.