Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization: Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial

Peter Clemmensen, Matthew T. Roe, Judith S. Hochman, Derek D. Cyr, Megan L. Neely, Darren K McGuire, Jan H. Cornel, Kurt Huber, Dmitry Zamoryakhin, Harvey D. White, Paul W. Armstrong, Keith A A Fox, Dorairaj Prabhakaran, Erik Magnus Ohman

Research output: Contribution to journalArticle

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Abstract

Background Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. Methods Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27%) patients participating in a platelet function substudy. Results Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P =.56), all-cause mortality (12.2% vs 11.7%; P =.88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P =.74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity. Conclusions Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.

Original languageEnglish (US)
Pages (from-to)695-705
Number of pages11
JournalAmerican Heart Journal
Volume170
Issue number4
DOIs
StatePublished - Oct 1 2015

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Unstable Angina
Acute Coronary Syndrome
Blood Platelets
clopidogrel
Sex Characteristics
Hemorrhage
Myocardial Infarction
Myocardial Revascularization
Mortality
Non-ST Elevated Myocardial Infarction
Aspirin
Cause of Death
Creatinine
Hemoglobins
Arteries
Stroke
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization : Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial. / Clemmensen, Peter; Roe, Matthew T.; Hochman, Judith S.; Cyr, Derek D.; Neely, Megan L.; McGuire, Darren K; Cornel, Jan H.; Huber, Kurt; Zamoryakhin, Dmitry; White, Harvey D.; Armstrong, Paul W.; Fox, Keith A A; Prabhakaran, Dorairaj; Ohman, Erik Magnus.

In: American Heart Journal, Vol. 170, No. 4, 01.10.2015, p. 695-705.

Research output: Contribution to journalArticle

Clemmensen, Peter ; Roe, Matthew T. ; Hochman, Judith S. ; Cyr, Derek D. ; Neely, Megan L. ; McGuire, Darren K ; Cornel, Jan H. ; Huber, Kurt ; Zamoryakhin, Dmitry ; White, Harvey D. ; Armstrong, Paul W. ; Fox, Keith A A ; Prabhakaran, Dorairaj ; Ohman, Erik Magnus. / Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization : Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial. In: American Heart Journal. 2015 ; Vol. 170, No. 4. pp. 695-705.
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abstract = "Background Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. Methods Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39{\%}]) and men (n = 5,676 [61{\%}]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27{\%}) patients participating in a platelet function substudy. Results Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2{\%} vs 19.1{\%}; P =.56), all-cause mortality (12.2{\%} vs 11.7{\%}; P =.88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8{\%} vs 2.8{\%}; P =.74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity. Conclusions Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.",
author = "Peter Clemmensen and Roe, {Matthew T.} and Hochman, {Judith S.} and Cyr, {Derek D.} and Neely, {Megan L.} and McGuire, {Darren K} and Cornel, {Jan H.} and Kurt Huber and Dmitry Zamoryakhin and White, {Harvey D.} and Armstrong, {Paul W.} and Fox, {Keith A A} and Dorairaj Prabhakaran and Ohman, {Erik Magnus}",
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T1 - Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

T2 - Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes trial

AU - Clemmensen, Peter

AU - Roe, Matthew T.

AU - Hochman, Judith S.

AU - Cyr, Derek D.

AU - Neely, Megan L.

AU - McGuire, Darren K

AU - Cornel, Jan H.

AU - Huber, Kurt

AU - Zamoryakhin, Dmitry

AU - White, Harvey D.

AU - Armstrong, Paul W.

AU - Fox, Keith A A

AU - Prabhakaran, Dorairaj

AU - Ohman, Erik Magnus

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. Methods Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27%) patients participating in a platelet function substudy. Results Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P =.56), all-cause mortality (12.2% vs 11.7%; P =.88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P =.74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity. Conclusions Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.

AB - Background Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. Methods Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n = 3,650 [39%]) and men (n = 5,676 [61%]) randomized to prasugrel 10 mg/d (5 mg/d for patients ≥75 years and/or <60 kg) versus clopidogrel 75 mg/d. Sex-specific differences in 30-day platelet reactivity were analyzed in 2,564 (27%) patients participating in a platelet function substudy. Results Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P =.56), all-cause mortality (12.2% vs 11.7%; P =.88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P =.74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality. There were no sex-specific, treatment-related differences in 30-day platelet reactivity. Conclusions Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after adjustment, significantly lower risk of the primary composite end point and all-cause death through 30 months.

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