Is There a Difference in STEMI Response Between Women and Men Undergoing PCI?

In age-matched women and men with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with everolimus-eluting stents (ESS),  there are “no differences in culprit plaque morphology and factors associated with coronary thrombosis,” and both women and men show similar vascular healing response to ESS, according to first-of-its-kind study published Aug. 13 in JACC: Cardiovascular Interventions.

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The OCTAVIA study was led by Giulio Guagliumi, MD, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy, and assessed in vivo sex differences in the pathophysiology of STEMI and vascular response to PCI. Drawing from 140 age-matched patients (70 men and 70 women), the authors investigated with intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers.

Results showed that both men and women had similar rates of plaque rupture (50.0 percent vs. 48.4 percent; risk ratio [RR]: 1.03; 95 percent confidence interval [CI]: 0.73 to 1.47; p = 0.56) while non-ruptured/eroded plaques comprised 25 percent of all cases (p = 0.86 in men vs. women). There were also no sex differences in the composition of aspirated thrombus, as well as immune and inflammatory serum biomarkers. At nine months women had a similar amount of in-stent neointimal obstruction (10.3 percent vs. 10.6 percent; p = 0.76) and strut coverage (90.9 percent vs. 92.5 percent; difference in medians: RR: 0.2 percent; 95 percent CI: –0.4 percent to 1.3 percent; p = 0.89) as men. At both the 30-day and one-year follow-up, no sex differences were found in clinical outcomes.

Based on the findings, the authors conclude that men and women with STEMI, when matched for age, shared remarkably similar plaque morphology, cellular composition, and immunohistochemistry of thrombus, as well as biomarker substrates. Both immediate and long-term vascular responses to EES implantation were also similar in both sexes. “These findings suggest that disparities in age, risk factors, timing of presentation, and management rather than different biological mechanisms and response to treatment might be more relevant in affecting clinical outcome,” they authors note.

Keywords: Odds Ratio, Myocardial Infarction, Follow-Up Studies, Biomarkers, Thrombosis, Tomography, Optical Coherence, Risk Factors, Coronary Thrombosis, Confidence Intervals, Sirolimus, Stents, Percutaneous Coronary Intervention

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