Sex-stratified differences in early antithrombotic treatment response in patients presenting with ST-segment elevation myocardial infarction
Description
Sex-stratified differences in early antithrombotic
treatment response in patients presenting with ST-segment elevation myocardial
infarction
Am
Heart J 2023 Apr; 258:17-26 doi: 10.1016
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.
Abstract
United States
