Cirillo Plinio, Di Serafino Luigi, Patti Giuseppe, Antonucci Emilia, Calabrò Paolo, Gresele Paolo, Palareti Gualtiero, Pengo Vittorio, Pignatelli Pasquale, Marcucci Rossella
1 Division of Cardiology, Department of Advanced Biomedical Sciences, School of Medicine, "Federico II" University, Naples, Italy.
2 Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Angiology. 2019 Mar;70(3):257-263. doi: 10.1177/0003319718783866. Epub 2018 Jul 3.
We investigated whether gender influences antiplatelet treatment in patients with acute coronary syndrome (ACS). The primary end point was major adverse cardiac and cerebrovascular events (MACCEs), a composite of death, myocardial infarction (MI), stroke, or target vessel revascularization. The coprimary end point was net adverse cardiac and cerebrovascular events (NACEs), based on MACCE plus major bleeding. From January 2014 to December 2016, 840 consecutive patients with ACS who completed 1-year follow-up were enrolled, 625 (74%) males and 215 (26%) females. Percutaneous coronary interventions (PCI) and drug-eluting stents (DES) were more often used in males (PCI: 532 [87%] vs 168 [80%], P = .02 and DES 474 [76%] vs 143 [66%], P = .01). Males were more often treated with dual antiplatelet therapy (DAPT; 94% vs 88%, P = .01). In DAPT, ticagrelor was the most prevalent strategy, regardless of gender (47% vs 49%, P = .68); clopidogrel was preferred in women (42% vs 33%, P = .04); and prasugrel was preferred in men (11% vs 17%, P = .04). At multivariate analysis, MACCE and NACE were similar between genders. Therefore, although PY inhibitor choice in DAPT might be influenced by gender, a DAPT choice, tailored by balancing the ischemic/bleeding risk, has a similar clinical outcome irrespective of gender.
我们研究了性别是否会影响急性冠脉综合征（ACS）患者的抗血小板治疗。主要终点是主要不良心脑血管事件（MACCE），其为死亡、心肌梗死（MI）、中风或靶血管血运重建的综合指标。共同主要终点是基于MACCE加严重出血的净不良心脑血管事件（NACE）。2014年1月至2016年12月，纳入了840例连续完成1年随访的ACS患者，其中男性625例（74%），女性215例（26%）。经皮冠状动脉介入治疗（PCI）和药物洗脱支架（DES）在男性中使用更为频繁（PCI：532例[87%]对168例[80%]，P = 0.02；DES：474例[76%]对143例[66%]，P = 0.01）。男性接受双联抗血小板治疗（DAPT）的比例更高（94%对88%，P = 0.01）。在DAPT中，无论性别，替格瑞洛都是最常用的策略（47%对49%，P = 0.68）；氯吡格雷在女性中更受青睐（42%对33%，P = 0.04）；普拉格雷在男性中更受青睐（11%对17%，P = 0.04）。多因素分析显示，MACCE和NACE在性别之间相似。因此，尽管DAPT中PY抑制剂的选择可能受性别影响，但通过平衡缺血/出血风险量身定制的DAPT选择，无论性别，临床结局相似。
