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(Circulation. 2005;111:1567.)
© 2005 American Heart Association, Inc.
Issue Highlights
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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GENDER DIFFERENCES IN OUTCOMES AFTER PRIMARY ANGIOPLASTY VERSUS PRIMARY STENTING WITH AND WITHOUT ABCIXIMAB FOR ACUTE MYOCARDIAL INFARCTION: RESULTS OF THE CONTROLLED ABCIXIMAB AND DEVICE INVESTIGATION TO LOWER LATE ANGIOPLASTY COMPLICATIONS (CADILLAC) TRIAL, by Lansky et al. |
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Prior studies have suggested that women presenting with acute myocardial infarction have increased short-term and longer-term mortality rates as compared with men. Investigators from the CADILLAC study, a large, multicenter randomized trial of different reperfusion modalities in acute myocardial infarction, analyzed their database to understand whether outcome varied by reperfusion approach. As noted by previous investigators, women presenting with acute myocardial infarction were older, had smaller body surface area, and had a higher burden of cardiovascular disease risk factors than did their male counterparts. Adjustment for baseline differences, particularly smaller body surface area, attenuated the sex differences in mortality rates. Notably, primary stenting (compared with percutaneous transluminal coronary angioplasty) reduced restenosis and significantly reduced major adverse cardiac events at 1 year in women. In addition, abciximab use with stenting diminished 30-day ischemia-related revascularization without an excess in bleeding and stroke complications. Confirming prior investigations, the investigators report an average 0.75-hour delay between myocardial infarction and percutaneous balloon intervention, which includes significant delays both in arriving to the emergency department and in being transferred from the emergency department to the catheterization laboratory. As the authors note, such major delays represent an important modifiable target to further improve outcomes for women in acute myocardial infarction. Interventions that can effectively reduce myocardial infarction treatment delays in women as well as men require further study and public health attention. See p 1611.
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THROMBOSIS MODULATES ARTERIAL DRUG DISTRIBUTION FOR DRUG-ELUTING STENTS, by Hwang et al. |
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Drug-eluting stents have reduced restenosis rates to the single-digit range, a benefit that has proven durable over several years of follow-up;
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