TY - JOUR
T1 - Sex-stratified differences in early antithrombotic treatment response in patients presenting with ST-segment elevation myocardial infarction
AU - Vogel, Rosanne F.
AU - Wilschut, Jeroen M.
AU - Lemmert, Miguel E.
AU - Diletti, Roberto
AU - van Vliet, Ria
AU - van der Waarden, Nancy W. P. L.
AU - Nuis, Rutger-Jan
AU - Paradies, Valeria
AU - Alexopoulos, Dimitrios
AU - Zijlstra, Felix
AU - Montalescot, Gilles
AU - Angiolillo, Dominick J.
AU - Krucoff, Mitchell W.
AU - Doevendans, Pieter A.
AU - van Mieghem, Nicolas M.
AU - Smits, Pieter C.
AU - Vlachojannis, Georgios J.
N1 - Funding Information: The COMPARE CRUSH trial was supported by Maasstad research B.V. (Rotterdam, the Netherlands ) , which received unrestricted grants from Daiichi-Sankyo [Grant number: 039-20170327-EFI ] and Shanghai MicroPort Medical [Grant number: MPSH20170801148570110945 ]. The funding companies were not involved in the conduct of the trial, the analysis of the data, or the drafts of the manuscripts. Publisher Copyright: © 2022 The Author(s)
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Background: The mechanisms underlying the increased risk of bleeding that female patients with ST-segment Elevation Myocardial Infarction (STEMI) exhibit, remains unclear. The present report assessed sex-related differences in response to pre-hospital dual antiplatelet therapy (DAPT) initiation in patients with STEMI. Methods: The COMPARE CRUSH trial randomized patients presenting with STEMI to receive a pre-hospital loading dose of crushed or integral prasugrel tablets in the ambulance. In this substudy, we compared platelet reactivity levels and the occurrence of high platelet reactivity (HPR; defined as platelet reactivity ≥208) between sexes at 4 prespecified time points after DAPT initiation, and evaluated post-PCI bleeding between groups. Results: Out of 633 STEMI patients, 147 (23%) were female. Females compared with males presented with significantly higher levels of platelet reactivity and higher HPR rates at baseline (232 [IQR, 209-256] vs 195 [IQR, 171-220], P < .01, and 76% vs 41%, OR 4.58 [95%CI, 2.52-8.32], P < .01, respectively). Moreover, female sex was identified as the sole independent predictor of HPR at baseline (OR 5.67 [95%CI, 2.56-12.53], P < .01). Following DAPT initiation, levels of platelet reactivity and the incidence of HPR were similar between sexes. Post-PCI bleeding occurred more frequently in females compared with males (10% vs 2%, OR 6.02 [95%CI, 2.61-11.87], P < .01). Female sex was an independent predictor of post-PCI bleeding (OR 3.25 [95%CI, 1.09-9.72], P = .04). Conclusions: In this contemporary STEMI cohort, female STEMI patients remain at risk of bleeding complications after primary PCI. However, this is not explained by sex-specific differences in the pharmacodynamic response to pre-hospital DAPT initiation.
AB - Background: The mechanisms underlying the increased risk of bleeding that female patients with ST-segment Elevation Myocardial Infarction (STEMI) exhibit, remains unclear. The present report assessed sex-related differences in response to pre-hospital dual antiplatelet therapy (DAPT) initiation in patients with STEMI. Methods: The COMPARE CRUSH trial randomized patients presenting with STEMI to receive a pre-hospital loading dose of crushed or integral prasugrel tablets in the ambulance. In this substudy, we compared platelet reactivity levels and the occurrence of high platelet reactivity (HPR; defined as platelet reactivity ≥208) between sexes at 4 prespecified time points after DAPT initiation, and evaluated post-PCI bleeding between groups. Results: Out of 633 STEMI patients, 147 (23%) were female. Females compared with males presented with significantly higher levels of platelet reactivity and higher HPR rates at baseline (232 [IQR, 209-256] vs 195 [IQR, 171-220], P < .01, and 76% vs 41%, OR 4.58 [95%CI, 2.52-8.32], P < .01, respectively). Moreover, female sex was identified as the sole independent predictor of HPR at baseline (OR 5.67 [95%CI, 2.56-12.53], P < .01). Following DAPT initiation, levels of platelet reactivity and the incidence of HPR were similar between sexes. Post-PCI bleeding occurred more frequently in females compared with males (10% vs 2%, OR 6.02 [95%CI, 2.61-11.87], P < .01). Female sex was an independent predictor of post-PCI bleeding (OR 3.25 [95%CI, 1.09-9.72], P = .04). Conclusions: In this contemporary STEMI cohort, female STEMI patients remain at risk of bleeding complications after primary PCI. However, this is not explained by sex-specific differences in the pharmacodynamic response to pre-hospital DAPT initiation.
UR - http://www.scopus.com/inward/record.url?scp=85146282258&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ahj.2022.12.013
DO - https://doi.org/10.1016/j.ahj.2022.12.013
M3 - Article
C2 - 36596332
SN - 0002-8703
VL - 258
SP - 17
EP - 26
JO - American Heart Journal
JF - American Heart Journal
ER -