Giulio Guagliumi1, Davide Capodanno2, Francesco Saia3, Giuseppe Musumeci4, Giuseppe Tarantini5, Roberto Garbo6, Gabriele Tumminello7, Vasile Sirbu4, Micol Coccato4, Massimo Fineschi8, Carlo Trani9, Mauro De Benedictis10, Ugo Limbruno11, Leonardo De Luca12, Giampaolo Niccoli13, Hiram Bezerra14, Elena Ladich15, Marco Costa14, Giuseppe Biondi Zoccai16, Renu Virmani15. 1. Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. Electronic address: guagliumig@gmail.com. 2. Cardiovascular Department, University of Catania, Catania, Italy. 3. Cardiovascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. 4. Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. 5. Cardiovascular Department, University of Padova Medical School, Padova, Italy. 6. Cardiovascular Department, Ospedale San Giovanni Bosco, Torino, Italy. 7. Cardiovascular Department, Ospedale Civile di Asti, Asti, Italy. 8. Cardiovascular Department, Policlinico S. Maria alle Scotte, Siena, Italy. 9. Catholic University of the Sacred Heart, Roma, Italy. 10. Cardiovascular Department, Ospedale Mauriziano, Torino, Italy. 11. Cardiovascular Department, Azienda Ospedaliera Grosseto, Grosseto, Italy. 12. Division of Cardiology, European Hospital-Aurelia Hospital, Roma, Italy. 13. Cardiovascular Department, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. 14. Cardiovascular Imaging Department, Case Western Reserve University, Cleveland, Ohio. 15. CV Path Institute, Gaithersburg, Maryland. 16. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy.
Abstract
OBJECTIVES: This study sought to assess in vivo sex differences in the pathophysiology of ST-segment elevation myocardial infarction (STEMI) and vascular response to primary percutaneous coronary intervention (PCI). BACKGROUND: There is no consensus on whether differences in the pathophysiology of STEMI and response to primary PCI between women and men reflect biological factors as opposed to differences in age. METHODS: In this prospective, multicenter study, 140 age-matched men and women with STEMI undergoing primary PCI with everolimus-eluting stent were investigated with intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers. 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: 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 to 1.47; p = 0.56). Nonruptured/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 men did. There were no sex differences in clinical outcome either at 30-day or 1-year follow-up. CONCLUSIONS: In 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. (Optical Coherence Tomography Assessment of Gender Diversity In Primary Angioplasty: The OCTAVIA Trial [OCTAVIA]; NCT01377207).
OBJECTIVES: This study sought to assess in vivo sex differences in the pathophysiology of ST-segment elevation myocardial infarction (STEMI) and vascular response to primary percutaneous coronary intervention (PCI). BACKGROUND: There is no consensus on whether differences in the pathophysiology of STEMI and response to primary PCI between women and men reflect biological factors as opposed to differences in age. METHODS: In this prospective, multicenter study, 140 age-matched men and women with STEMI undergoing primary PCI with everolimus-eluting stent were investigated with intravascular optical coherence tomography, histopathology-immunohistochemistry of thrombus aspirates, and serum biomarkers. 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: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 to 1.47; p = 0.56). Nonruptured/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 men did. There were no sex differences in clinical outcome either at 30-day or 1-year follow-up. CONCLUSIONS: In 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. (Optical Coherence Tomography Assessment of Gender Diversity In Primary Angioplasty: The OCTAVIA Trial [OCTAVIA]; NCT01377207).
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Authors: Keva Garg; Toral R Patel; Arjun Kanwal; Todd C Villines; Niti R Aggarwal; Khurram Nasir; Roger S Blumenthal; Michael J Blaha; Pamela S Douglas; Leslee J Shaw; Garima Sharma Journal: J Cardiovasc Comput Tomogr Date: 2021-10-08
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