Author + information
- Received September 29, 2015
- Accepted October 22, 2015
- Published online March 28, 2016.
- Marlies M. Kok, MDa,
- Liefke C. van der Heijden, MDa,
- Hanim Sen, MD, PhDa,
- Peter W. Danse, MD, PhDb,
- Marije M. Löwik, PhDa,
- Rutger L. Anthonio, MD, PhDc,
- J. (Hans) W. Louwerenburg, MDa,
- Frits H.A.F. de Man, MD, PhDa,
- Gerard C.M. Linssen, MD, PhDd,
- Maarten J. IJzerman, PhDe,
- Carine J.M. Doggen, PhDe,
- Angela H.E.M. Maas, MD, PhDf,
- Roxana Mehran, MDg and
- Clemens von Birgelen, MD, PhDa,e,∗ ()
- aDepartment of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- bDepartment of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
- cDepartment of Cardiology, Scheper Hospital, Emmen, the Netherlands
- dDepartment of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands
- eHealth Technology and Services Research, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
- fChair of Cardiology for Women, Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
- gThe Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Mount Sinai Medical Center, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. C. von Birgelen, Thoraxcentrum Twente and University of Twente, Medisch Spectrum Twente, Department of Cardiology, Postbus 50.000, 7500 KA Enschede, the Netherlands.
Objectives This study sought to assess sex differences in chest pain after percutaneous coronary intervention (PCI) with newer generation drug-eluting stents (DES).
Background Sex-based data on chest pain after PCI with DES are scarce.
Methods The authors performed a patient-level pooled analysis of the TWENTE and DUTCH PEERS randomized trials, in which patients were treated with newer generation permanent polymer-coated DES. At 1 and 2 years, clinical follow-up was available in 99.8% and patient-reported chest pain data in 94.1% and 93.6%, respectively.
Results Among all 3,202 patients, the 871 (27.2%) women were older (67.5 ± 10.2 years vs. 62.8 ± 10.6 years; p < 0.001) and had more cardiovascular risk factors: diabetes (24.2% vs. 17.8%; p < 0.001), hypertension (63.6% vs. 51.6%; p < 0.001), and positive family history (54.5% vs. 50.1%; p = 0.03). At 1- and 2-year follow-up, women reported more clinically relevant chest pain (16.3% vs. 10.5%; p < 0.001, and 17.2% vs. 11.1%; p < 0.001, respectively). Multivariate analysis demonstrated that female sex independently predicted clinically relevant chest pain at 1- and 2-year follow-up both during daily activities and at minimum physical exertion/at rest (1 year adjusted odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.2 to 2.4; p = 0.002; and adjusted OR: 1.8; 95% CI: 1.3 to 2.5; p < 0.001; 2-year adjusted OR: 1.8; 95% CI: 1.3 to 2.6; p < 0.001; and adjusted OR: 1.7; 95% CI: 1.3 to 2.3; p = 0.001). Nevertheless, the 2-year rates of death, myocardial infarction, revascularization, stent thrombosis, and various composite clinical endpoints were similar for both sexes.
Conclusions Although the incidence of adverse cardiovascular events was low and similar for both sexes, women showed a statistically significantly higher prevalence of clinically relevant chest pain, which might be largely related to mechanisms other than epicardial coronary obstruction.
- chest pain
- sex analysis
- newer generation drug-eluting stent(s)
- percutaneous coronary intervention
- randomized clinical trial
- second-generation drug-eluting stent(s)
The present study was performed without any external funding. The TWENTE and DUTCH PEERS (TWENTE II) randomized trials were supported by equal unrestricted grants from Abbott Vascular and Medtronic, and from Boston Scientific and Medtronic, respectively.
Dr. Maas has received honoraria for lectures from Merck Sharp & Dohme and AstraZeneca. Dr. Mehran has received institutional research grant support from The Medicines Company, Bristol-Myers Squibb-Sanofi, Daiichi Sankyo-Lilly, and STENTYS; consulting fees from Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, CSL Behring, Janssen Pharmaceuticals, Maya Medical, Merck, and Regado Biosciences; and serves on the advisory boards of Covidien, Janssen Pharmaceuticals, Merck, Sanofi, and Endothelix, Inc. Dr. von Birgelen has been a consultant to Abbott Vascular, Boston Scientific, and Medtronic; and has received lecture fees from AstraZeneca and Merck Sharp & Dohme; his institution has received research grants, provided by Abbott Vascular, Biotronik, Boston Scientific, Medtronic, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 29, 2015.
- Accepted October 22, 2015.
- American College of Cardiology Foundation