Mechanisms of Atherothrombosis and Vascular Response to Primary Percutaneous Coronary Intervention in Women Versus Men With Acute Myocardial Infarction: Results of the OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty) Study

Study Questions:

Are there sex-related differences in the pathophysiology of ST-segment elevation myocardial infarction (STEMI) and response to primary percutaneous coronary intervention (PCI)?

Methods:

The OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty) study was a prospective, multicenter, controlled trial involving patients with STEMI undergoing primary PCI with everolimus-eluting stenting in 14 centers. Consecutive patients who presented within 6 hours following the onset of symptoms with STEMI were included, with the exception of those who had cardiogenic shock, renal failure, recent major bleeding, allergy to aspirin or clopidogrel, and anticoagulant therapy. Intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers were examined in each participant. Primary endpoints were the percentages of culprit plaque rupture at baseline and everolimus-eluting stent strut coverage at 9-month follow-up, as determined by optical coherence tomography.

Results:

A total of 140 age-matched men and women were included in the study between January 2011 and January 2012. Baseline characteristics were similar in men and women, with the exception of lower body surface area and TIMI risk score (median: 4 vs. 3, p < 0.001) in women versus men. Time from symptom onset to arrival in the catheterization laboratory was shorter in men than in women. Men and women had similar rates of plaque rupture (50.0% vs. 48.4%; risk ratio [RR], 1.03; 95% confidence interval [CI], 0.73-1.47; p = 0.56). Nonruptured or eroded plaques comprised 25% of all cases (p = 0.86 in men vs. women). There were no sex differences in composition of aspirated thrombus and immune and inflammatory serum biomarkers. At 9 months, women had similar strut coverage (90.9% vs. 92.5%; difference in medians: RR, 0.2%; 95% CI, –0.4% to 1.3%; p = 0.89) and amount of in-stent neointimal obstruction (10.3% vs. 10.6%; p = 0.76) as the men. There were no sex differences in clinical outcome either at 30-day or 1-year follow-up.

Conclusions:

The investigators concluded that among patients presenting with STEMI undergoing primary PCI, no differences in culprit plaque morphology and factors associated with coronary thrombosis were observed between age-matched men and women. Women also showed similar vascular healing response to everolimus-eluting stents as men did.

Perspective:

Prior research has suggested sex-related differences in STEMI, with men having more plaque rupture and women more plaque erosion. Data from OCTAVIA suggest similar plaque morphology. Furthermore, no differences were observed in clinical outcomes, suggesting similar vascular response to everolimus-eluting stents for women and men.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Acute Heart Failure, Interventions and Imaging

Keywords: Myocardial Infarction, Tomography, Optical Coherence, Angioplasty, Balloon, Coronary, Percutaneous Coronary Intervention, Stents, Shock, Cardiogenic, Renal Insufficiency, Body Surface Area, Immunohistochemistry, Catheterization, Hypersensitivity, Coronary Thrombosis


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