1 / 51

Nick Curzen PhD FRCP FESC Wessex Cardiothoracic Unit Southampton

The Use of Adjuvant Medical Therapies During PCI: Are There Gender Differences?. Nick Curzen PhD FRCP FESC Wessex Cardiothoracic Unit Southampton. Yeah, right!. PCI: Women versus Men?. Well established that……………………. Female coronary arteries smaller Relatively protected by oestrogen

axelle
Download Presentation

Nick Curzen PhD FRCP FESC Wessex Cardiothoracic Unit Southampton

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. The Use of Adjuvant Medical Therapies During PCI: Are There Gender Differences? Nick Curzen PhD FRCP FESC Wessex Cardiothoracic Unit Southampton

  2. Yeah, right!

  3. PCI: Women versus Men?

  4. Well established that…………………….. • Female coronary arteries smaller • Relatively protected by oestrogen • Women have increased clotting tendency • Women present older and later with ACS • Women’s symptoms less often typical • ETT less useful • Invasive assessment & revascularisation underutilised • Worse outcome after CABG • Higher complication rates in acute MI • Less invasive investigation and treatment • More complications – especially bleeding • Less secondary prevention

  5. Well established that…………………….. • Female coronary arteries smaller • Relatively protected by oestrogen • Women have increased clotting tendency • Women present older and later with ACS • Women’s symptoms less often typical • ETT less useful • Invasive assessment & revascularisation underutilised • Worse outcome after CABG • Higher complication rates in acute MI

  6. Well established that…………………….. • Female coronary arteries smaller • Relatively protected by oestrogen • Women have increased clotting tendency • Women present older and later with ACS • Women’s symptoms less often typical • ETT less useful • Invasive assessment & revascularisation underutilised • Worse outcome after CABG • Higher complication rates in acute MI • Higher complication rates in PCI

  7. Well established that…………………….. • Female coronary arteries smaller • Relatively protected by oestrogen • Women have increased clotting tendency • Women present older and later with ACS • Women’s symptoms less often typical • ETT less useful • Invasive assessment & revascularisation underutilised • Worse outcome after CABG • Higher complication rates in acute MI • Higher complication rates in PCI

  8. GPIIbIIIa Inhibitors With PCI… How Do Women Do?

  9. ACS+ PCI + Women: The Role of GPIIbIIIa inhibitors

  10. Aggressive Revasc in ACS: Do Women Receive the Same Treatment?

  11. Aggressive Revasc in ACS: Do Women Do Less Well? …… And Is It Drug Related

  12. TACTICS - Study Death, AMI, Rehosp. : 6 months 19.4% 15.9% 30 days OR=0.51 P=0.002 20 conserv. 16 % patients 12 O.R. 0.78 95% CI (0.62, 0.97) p=0.025 invasive 8 4 • Same degree of benefit in women and men • All patients received IIb IIIa inhibitor 0 0 1 2 3 4 5 6 Months

  13. FRISC II (Fragmin & Fast Revascularisation during Instability in Coronary artery Disease) • Different outcome in women and men • Low use of IIb IIAa (10%)

  14. So - Why are the results of TACTICS-TIMI18 discrepant with FRIC-II & RITA-3?

  15. TACTICS - Troponin T Death, AMI, Rehosp. 6 Months CONS INV p<0.001 OR=0.52 Interaction P<0.001 p=NS (%) N= 414 396 463 495 TnT > 0.01 ng/ml (54% of Pts TnT +)

  16. Maybe the nature of the vascular inflammatory response is different in women…… & maybe there are also other subtler differences…………..?

  17. Platelets 2006;17:385-92. A Novel Fifteen Minute Test for Assessment of Individual Time-dependent Clotting Responses to Aspirin and Clopidogrel using Modified Thrombelastography. A Hobson1, G Petley2, K Dawkins1, N Curzen1,4 AUC of AA channel 6 hrs post aspirin. (p=0.038)

  18. AUC of the TEG fibrin channel at baseline. (P=0.00002) Baseline AUC15 of TEG Thrombin channel. P=0.004 Thanks to Alex Hobson AUC of AA channel at baseline. (P=0.005) Baseline responses to ADP stimulation (p=0.001)

  19. STEMI: Women & Thrombolytics……… & PCI?

  20. STEMI: Women & Thrombolytics……… & PCI?

  21. PCI & Bivalirudin in Women

  22. Are Other Adjunctive Therapies Gender-Fair?

  23. SUMMARY • Women are not the same as men • Nor are their coronary arteries • They have higher baseline platelet reactivity • They present differently • They are investigated and treated less aggressively • They may be given less secondary prevention Rx • They have more complications in MI • They have more complications with PCI … especially bleeding • In ACS: they have different levels of some markers of inflammation • They may respond less well to early invasive revasc in ACS? • But they have the same benefit in ACS PCI from IIb IIIa inhibitors • Women are difficult to understand but we need to try harder

More Related