Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

Maria Virginia Manzi; Sergio Buccheri; Sanjit S. Jolly; Felix Zijlstra; Ole Frøbert; Bo Lagerqvist; Karim D. Mahmoud; Vladimír Džavík; Emanuele Barbato; Giovanna Sarno; Stefan James

doi:10.1016/j.jcin.2022.08.013

Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

Maria Virginia Manzi^*, Sergio Buccheri, Sanjit S. Jolly, Felix Zijlstra, Ole Frøbert, Bo Lagerqvist, Karim D. Mahmoud, Vladimír Džavík, Emanuele Barbato, Giovanna Sarno, Stefan James

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

11 Citations (Scopus)

Abstract

Background: Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated. Objectives: The aim of this study was to assess the sex-related differences in TB and its clinical implications in patients with STEMI. Methods: Individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration were analyzed, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year. Results: Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death: 1.52; 95% CI: 1.10-2.12; P = 0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, the risk for 1-year CV death was higher only in women with HTB (HR: 1.23; 95% CI: 1.18-1.28; P < 0.001), who also had an increased risk for all-cause death and ST than men. Conclusions: In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for ST, CV, and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.

Original language	English
Journal	JACC: Cardiovascular Interventions
Volume	15
Issue	20
Pages (from-to)	2066-2076
Number of pages	11
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2022.08.013
Publication status	Published - Oct 2022
Externally published	Yes

Keywords

ST-segment elevation myocardial infarction
TAPAS
TASTE
TIMI thrombus burden
TOTAL
women
Percutaneous Coronary Intervention/adverse effects
Humans
Male
ST Elevation Myocardial Infarction/diagnostic imaging
Treatment Outcome
Thrombectomy/adverse effects
Neoplasm Recurrence, Local/complications
Female
Coronary Thrombosis/diagnostic imaging

Access to Document

10.1016/j.jcin.2022.08.013Licence: CC BY-NC-ND

Cite this

Manzi, M. V., Buccheri, S., Jolly, S. S., Zijlstra, F., Frøbert, O., Lagerqvist, B., Mahmoud, K. D., Džavík, V., Barbato, E., Sarno, G., & James, S. (2022). Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions, 15(20), 2066-2076. https://doi.org/10.1016/j.jcin.2022.08.013

@article{28685603519d4806a695c820e39bb743,

title = "Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention",

abstract = "Background: Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated. Objectives: The aim of this study was to assess the sex-related differences in TB and its clinical implications in patients with STEMI. Methods: Individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration were analyzed, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year. Results: Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death: 1.52; 95% CI: 1.10-2.12; P = 0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, the risk for 1-year CV death was higher only in women with HTB (HR: 1.23; 95% CI: 1.18-1.28; P < 0.001), who also had an increased risk for all-cause death and ST than men. Conclusions: In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for ST, CV, and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.",

keywords = "ST-segment elevation myocardial infarction, TAPAS, TASTE, TIMI thrombus burden, TOTAL, women, Percutaneous Coronary Intervention/adverse effects, Humans, Male, ST Elevation Myocardial Infarction/diagnostic imaging, Treatment Outcome, Thrombectomy/adverse effects, Neoplasm Recurrence, Local/complications, Female, Coronary Thrombosis/diagnostic imaging",

author = "Manzi, {Maria Virginia} and Sergio Buccheri and Jolly, {Sanjit S.} and Felix Zijlstra and Ole Fr{\o}bert and Bo Lagerqvist and Mahmoud, {Karim D.} and Vladim{\'i}r D{\v z}av{\'i}k and Emanuele Barbato and Giovanna Sarno and Stefan James",

note = "Funding Information: Dr Manzi has received a research grant from the European Society of Cardiology during the conduct of this study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = oct,

doi = "10.1016/j.jcin.2022.08.013",

language = "English",

volume = "15",

pages = "2066--2076",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "20",

}

Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention. / Manzi, Maria Virginia; Buccheri, Sergio; Jolly, Sanjit S. et al.
In: JACC: Cardiovascular Interventions, Vol. 15, No. 20, 10.2022, p. 2066-2076.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

AU - Manzi, Maria Virginia

AU - Buccheri, Sergio

AU - Jolly, Sanjit S.

AU - Zijlstra, Felix

AU - Frøbert, Ole

AU - Lagerqvist, Bo

AU - Mahmoud, Karim D.

AU - Džavík, Vladimír

AU - Barbato, Emanuele

AU - Sarno, Giovanna

AU - James, Stefan

N1 - Funding Information: Dr Manzi has received a research grant from the European Society of Cardiology during the conduct of this study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 The Authors

PY - 2022/10

Y1 - 2022/10

N2 - Background: Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated. Objectives: The aim of this study was to assess the sex-related differences in TB and its clinical implications in patients with STEMI. Methods: Individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration were analyzed, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year. Results: Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death: 1.52; 95% CI: 1.10-2.12; P = 0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, the risk for 1-year CV death was higher only in women with HTB (HR: 1.23; 95% CI: 1.18-1.28; P < 0.001), who also had an increased risk for all-cause death and ST than men. Conclusions: In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for ST, CV, and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.

AB - Background: Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated. Objectives: The aim of this study was to assess the sex-related differences in TB and its clinical implications in patients with STEMI. Methods: Individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration were analyzed, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year. Results: Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death: 1.52; 95% CI: 1.10-2.12; P = 0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, the risk for 1-year CV death was higher only in women with HTB (HR: 1.23; 95% CI: 1.18-1.28; P < 0.001), who also had an increased risk for all-cause death and ST than men. Conclusions: In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for ST, CV, and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.

KW - ST-segment elevation myocardial infarction

KW - TAPAS

KW - TASTE

KW - TIMI thrombus burden

KW - TOTAL

KW - women

KW - Percutaneous Coronary Intervention/adverse effects

KW - Humans

KW - Male

KW - ST Elevation Myocardial Infarction/diagnostic imaging

KW - Treatment Outcome

KW - Thrombectomy/adverse effects

KW - Neoplasm Recurrence, Local/complications

KW - Female

KW - Coronary Thrombosis/diagnostic imaging

UR - http://www.scopus.com/inward/record.url?scp=85139283255&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2022.08.013

DO - 10.1016/j.jcin.2022.08.013

M3 - Journal article

C2 - 36265938

AN - SCOPUS:85139283255

SN - 1936-8798

VL - 15

SP - 2066

EP - 2076

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 20

ER -

Sex-Related Differences in Thrombus Burden in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this