| Objective: The goal of this study was to investigate the impact of gender on clinical outcomes after coronary revascularization with stents implantation.Methods: The study of the Optimal Antiplatelet Therapy for Chinese Patients With Coronary Artery Disease(OPT-CAD)(U.S.National Institutes of Health,Clinical Trials.gov Identifier: NCT:01735305)was the sub-study of the Twelfth Five-Year Plan of the national science and technology project,project number 2011BAI11B07).The OPT-CAD study was a prospective,large-scale,multicenter conducted,registered trial.14032 consecutive patients with coronary artery disease were included between 2012 and 2014.We performed a analysis using 9053 patients(2170 women,6883 men)who underwent PCI with stents from the OPT-CAD study.The primary endpoint was 12-month major adverse cardiac and cerebrovascular events(MACCE),a composite of all-cause death,myocardial infarction,stroke,target vessel revascularization or non-target vessel revascularization.The second endpoint was 12-month net adverse clinical events(NACE),including MACCE and total bleeding events.Bleeding definitions were based on Bleeding Academic Research Consortium(BARC)criteria.Cox proportional hazards models were constructed to study the influence of gender on MACCE and total bleeding events.Results: Compared with men,women undergoing PCI were older(65.51 ± 9.11 years vs.59.33 ± 10.83 years,P<0.001)and more frequently had comorbidities such as hypertension(71.15% vs.55.76%,P<0.001)and diabetes mellitus(31.06% vs.23.06%,P<0.001),less frequently had current smoking habits(1.84% vs.12.60%,P<0.001),prior myocardial infarction(7.88% vs.11.61%,P<0.001),prior PCI(17.74% vs.20.62%,P=0.004).In angiographic characteristics and procedural results,women had a smaller reference vessel diameter(2.97 ± 0.38 mm vs.3.07 ± 0.41 mm,P <0.001),smaller percent stenosis of the target lesion(88.57 ± 9.54 vs.89.77 ± 9.41,P<0.001),and received fewer stents/case(1.64 ± 0.88 vs.1.66 ± 0.94,P=0.023).Total stent length(42.18 ± 27.47 vs.40.97 ± 25.50,P=0.060)did not differ significantly between genders.At 12 month,MACCE(8.32% vs.9.03%,P=0.303),death(1.57% vs.1.98%,P=0.191),myocardial infarction(0.96% vs.1.11%,P=0.547),any revascularization(5.84% vs.5.16%,P=0.233),target vessel revascularization(2.02% vs.1.57%,P=0.179)was comparable between men and women.Women had a higher rate of NACE(16.82 % vs.13.98%,P=0.001),stroke(1.05% vs.1.89%,P=0.002)and total bleeding events(8.39% vs.6.17%,P <0.001)at 1 year.Multivariate analysis showed that older patients(?65 years old)(HR 1.282;95% CI 1.092,1.505;P = 0.002),diabetes mellitus(HR 1.361;95% CI 1.166,1.588;P <0.001),previous stroke(HR 1.340;95% CI 1.052,1.709;P = 0.018),left ventricular ejection fraction <50%(HR 1.325;95% CI 1.083,1.621;P = 0.006),longer total stent length(HR 1.036;95% CI 1.003,1.071;P = 0.031),severer percent stenosis of the target lesion(HR 1.157;95% CI 1.064,1.257;P = 0.001)other than female gender were the significant predictors of MACCE.Female gender(HR 1.416;95% CI 1.153,1.739;P = 0.001),hypertension(HR 1.329;95% CI 1.117,1.582;P = 0.001)were the significant predictors of total bleeding events.Conclusion:.No differences in the rates of MACCE were observed between men and women at 1 year.Women had a higher rate of total bleeding events at 1 year.Older patients(?65 years old),diabetes mellitus,previous stroke,left ventricular ejection fraction <50%,longer total stent length,severer percent stenosis of the target lesion other than female gender were the predictors of MACCE.Female gender,hypertension were the significant predictors of total bleeding events. |
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