摘要
背景:当前对女性接受经皮冠状动脉介入(PCI)后果的界定远不完善。REPLACE-2试验证实,就缺血和出血终点事件而言,在PCI时应用比伐卢定+临时糖蛋白IIb/IIIa(GpIIb-IIIa)阻断剂的后果并不劣于应用肝素+计划性GpIIb-IIIa阻断剂的后果。
Background: Outcomes in women undergoing percutaneous coronary intervention(PCI) in the contemporary era are poorly defined. The REPLACE-2 trial demonstrated that bivalirudin with provisional glycoprotein IIb/IIIa(GpIIb-IIIa) blockade is noninferior to heparin with planned GpIIb-IIIa blockade during PCI, with regard to ischemic and bleeding end points. Objectives: The aim of this study was to define sex-based clinical ischemic and bleeding outcomes from the REPLACE-2 trial. Methods: A retrospective sex-based subgroup analysis of the REPLACE-2 trial comparing clinical ischemic and inhospital bleeding end points was conducted. Results: Compared with men in REPLACE-2, women were older, had more diabetes, congestive heart failure and hypertension, and less prior revascularization and myocardial infarction. Female sex was a univariate predictor of death and bleeding complications. Among women treated with either bivalirudin or heparin, there was no significant difference in the individual or composite ischemic end points of death, myocardial infarction, or urgent revascularization at 30 days or 6 months. Protocol-defined major bleeding, minor bleeding, and access site bleeding were less frequent with bivalirudin compared with heparin. Multivariable modeling found no significant interactions between sexes, with the composite ischemic end point, major bleeding, or 1-year mortality. Conclusions: Women remain at higher risk for poorer outcomes with contemporary PCI, likely because of comorbidities. Bivalirudin with provisional GpIIb-IIIa confers similar protection against ischemic end points compared with heparin and planned GpIIb-IIIa blockade and significantly reduces the inherent bleeding risk of women undergoing contemporary PCI.
