Impact of Gender and Antithrombin Strategy on Early and Late Clinical Outcomes in Patients With Non-ST-Elevation Acute Coronary Syndromes (from the ACUITY Trial)
Impact of Gender and Antithrombin Strategy on Early and Late Clinical Outcomes in Patients With Non-ST-Elevation Acute Coronary Syndromes (from the ACUITY Trial)
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DOI：
10.1016/j.amjcard.2009.01.030
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发表时间：
2009-05-01
影响因子：
2.8
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
--
作者：
Lansky, Alexandra J.;Mehran, Roxana;Stone, Gregg W.
与男性相比，患有非ST段抬高的急性冠脉综合征的女性发生缺血和出血并发症的风险更高。在ACINITY试验中，我们研究了性别和抗血栓治疗对非ST段抬高急性冠脉综合征患者预后的影响。患者被随机分为肝素(未治疗或依诺肝素)加糖蛋白IIb/IIIa抑制剂(GPI)、比伐卢定加GPI或单独用比伐卢定。我们比较了(1)接受经皮冠状动脉介入治疗(PCI)的男性和女性，以及(2)接受抗血栓治疗的女性和男性的非冠状动脉旁路移植术、复合缺血(死亡、心肌梗死或血运重建)和净临床结果(复合缺血或出血)的主要出血。在13,819名患者中，有4,157名是女性(30.1%)。女性30天的复合缺血率相似(7%比8%，p=0.07)，但30天大出血的发生率更高(8%比3%，p=0.07)。
Women with non-ST-elevation acute coronary syndrome are at increased risk for ischemic and bleeding complications compared with men. We examined the impact of gender and antithrombotic therapy for non-ST-elevation acute coronary syndrome on outcomes in patients in the ACUITY trial. Patients were randomized to heparin (unfiractionated or enoxaparin) plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin alone. We compared major bleeding unconnected to coronary artery bypass grafting, composite ischemia (death, myocardial infarction, or revascularization), and net clinical outcome (composite ischemia or bleeding) in (1) men versus women overall and undergoing percutaneous coronary intervention (PCI) and (2) women overall and undergoing PCI by antithrombotic strategy. Of 13,819 patients enrolled, 4,157 were women (30.1%). Women had similar 30-day composite ischemia (7% vs 8%, p = 0.07) but greater 30-day rates of major bleeding (8% vs: 3% p