东亚经皮冠状动脉介入治疗药物洗脱支架后高血小板反应性的中期预后意义中的性别差异：来自 PTRG-DES（冠心病药物洗脱支架治疗患者血小板功能和基因型相关长期预后）联盟的结果。

Sex Differences in Midterm Prognostic Implications of High Platelet Reactivity After Percutaneous Coronary Intervention With Drug-Eluting Stents in East Asian Patients: Results From the PTRG-DES (Platelet Function and Genotype-Related Long-Term Prognosis in Drug-Eluting Stent-Treated Patients With Coronary Artery Disease) Consortium.

机构信息

Division of Cardiology, Department of Internal Medicine Kosin University College of Medicine Busan South Korea.

Division of Cardiology, Department of Internal Medicine Kangwon National University School of Medicine Chuncheon South Korea.

出版信息

J Am Heart Assoc. 2023 May 2;12(9):e027804. doi: 10.1161/JAHA.122.027804. Epub 2023 Apr 29.

Background Although high platelet reactivity (HPR) on clopidogrel is associated with higher ischemic events and lower bleeding events in patients who have undergone percutaneous coronary intervention with drug-eluting stents, the differential risk of HPR in East Asian women versus men is unknown. Methods and Results We compared 11 714 patients enrolled in the PTRG-DES (Platelet Function and Genotype-Related Long-Term Prognosis in Drug-Eluting Stent-Treated Patients With Coronary Artery Disease) Consortium according to sex and the presence/absence of HPR on clopidogrel (defined as ≥252 P2Y12 reactivity units). The primary study end point was major adverse cardiac and cerebrovascular events (MACCEs; comprising all-cause mortality, myocardial infarction, cerebrovascular accident, and stent thrombosis). HPR was more common in women (46.7%) than in men (28.1%). In propensity-adjusted models, HPR was an independent predictor of MACCEs (men with HPR: hazard ratio [HR], 1.60 [95% CI, 1.20-2.12]; women with HPR: HR, 0.99 [95% CI, 0.69-1.42]) and all-cause mortality (men with HPR: HR, 1.61 [95% CI, 1.07-2.44]; women with HPR: HR, 0.92 [95% CI, 0.57-1.50]) in men, although those associations were insignificant among women. In addition, a significant interaction between sex was noted in the associations between HPR and MACCE (=0.013) or all-cause mortality (=0.025). Conclusions In this study, HPR was a differential risk factor for 1-year MACCEs and all-cause mortality in women and men. And it was an independent predictor of 1-year MACCEs and all-cause mortality in men but not in women. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04734028. Registered July 9, 2003, https://clinicaltrials.gov/ct2/show/NCT04734028.

背景

尽管在接受药物洗脱支架经皮冠状动脉介入治疗的患者中，氯吡格雷的高血小板反应性（HPR）与更高的缺血事件和更低的出血事件相关，但东亚女性与男性之间 HPR 的差异风险尚不清楚。

方法和结果

我们根据性别和氯吡格雷 HPR（定义为≥252 P2Y12 反应单位）的存在/不存在，比较了参与 PTRG-DES（冠心病患者药物洗脱支架治疗后的血小板功能和基因型相关长期预后）研究联盟的 11714 名患者。主要研究终点是主要不良心脏和脑血管事件（MACCEs；包括全因死亡率、心肌梗死、脑血管意外和支架血栓形成）。HPR 在女性（46.7%）中比男性（28.1%）更为常见。在倾向调整模型中，HPR 是 MACCEs 的独立预测因子（男性 HPR：风险比[HR]，1.60 [95%CI，1.20-2.12]；女性 HPR：HR，0.99 [95%CI，0.69-1.42]）和全因死亡率（男性 HPR：HR，1.61 [95%CI，1.07-2.44]；女性 HPR：HR，0.92 [95%CI，0.57-1.50]），尽管在女性中这些关联无统计学意义。此外，在 HPR 与 MACCE（=0.013）或全因死亡率（=0.025）之间的关联中，观察到性别之间存在显著的交互作用。