Sex-specific differences in antithrombotic therapy and prognosis in patients with acute coronary syndrome treated with stent

Aims and objective: Impact of sex-related differences in patients with the acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterized. We aimed to analyze gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events. Materials and methods: Prospective-observational study of the consecutive ACS patients treated with stent from July 2015 to January 2016, with a follow-up of 1 year. Results: We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 +/- 13 vs. 66.5 +/- 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischemic risk (Global Registry of Acute Coronary Events and thrombolysis in myocardial infarction). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favor of clopidogrel. No differences were observed in the prasugrel prescription. No significant differences were observed after a year of follow-up, but women had a tendency toward lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27). Conclusions: In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency toward less mortality and more bleeding events.