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Outcomes in Women and Minorities After Everolimus-Eluting Stent Implantation
Study Questions:
What are the 1-year outcomes in women and minorities versus white men after percutaneous coronary intervention (PCI) with everolimus-eluting stents?
Methods:
Data from the PLATINUM Diversity study were used for the present analysis, which enrolled 1,501 women and minorities from 52 sites in the United States. Patient-level pooling with the PROMUS Element Plus Post-Approval Study was prespecified. The PROMUS Element Plus Post-Approval study enrolled 2,681 patients at 52 US sites. Enrollment for all participants began in October 2014, with participant follow-up for 12 months. Patients all received ≥1 everolimus-eluting stent(s). The primary endpoint of interest was major adverse cardiac events (MACE) at 1 year. Death, myocardial infarction (MI), and target vessel revascularization were included in this combined endpoint. Secondary ischemic endpoints were also evaluated.
Results:
A total of 4,182 patients including 1,635 white men (39.1%), 1,863 women (44.5%) (white and minority), and 1,059 (25.3%) minority patients (women and men) were included. Women and minorities had a higher prevalence of diabetes, prior stroke, hypertension, renal disease, and congestive heart failure than white men, but lower rates of multivessel disease, prior coronary artery bypass graft surgery, prior MI, and smoking. Unadjusted 1-year MACE rates (white men, 7.6%; women, 8.6%; minorities, 9.6%) were similar between groups, with no significant differences after risk adjustment. The adjusted risk of death/MI was higher among women (odds ratio, 1.6; 95% confidence interval [CI], 1.1-2.4) and minorities (odds ratio, 1.9; 95% CI, 1.2-2.8) compared with white men. The adjusted risk of MI was higher in minorities (odds ratio, 2.6; 95% CI, 1.4-4.8). These differences were driven primarily by nonstent-related MIs. Among women and minority participants, the independent predictors of MACE were cardiogenic shock, renal disease, history of peripheral vascular disease, multivessel disease, widowhood, and lack of private insurance.
Conclusions:
The investigators concluded that, after contemporary everolimus-eluting stent implantation, women and minorities experience a similar risk of 1-year MACE, but a higher adjusted risk of recurrent ischemic events, primarily because of nonstent-related MIs. Both clinical and angiographic factors and social determinants of health, including widowhood and insurance status, contribute to 1-year MACE among women and minorities.
Perspective:
These data provide insight in the factors that contribute to gender-related differences in outcomes after stent placement.
Keywords: Acute Coronary Syndrome, Coronary Artery Bypass, Diabetes Mellitus, Drug-Eluting Stents, Heart Failure, Hypertension, Insurance Coverage, Minority Health, Myocardial Ischemia, Myocardial Infarction, Outcome Assessment, Health Care, Percutaneous Coronary Intervention, Peripheral Vascular Diseases, Renal Insufficiency, Risk Adjustment, Secondary Prevention, Shock, Cardiogenic, Smoking, Stroke, Widowhood, Women
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