Sex Differences in Platelet Reactivity and Five-Year Outcomes With Extended Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation

초록

BACKGROUND: Data on long-term ischemic and bleeding outcomes according to sex and platelet reactivity in East Asian patients receiving extended dual antiplatelet therapy (DAPT; >12 months) after successful drug-eluting stent implantation are limited. We investigated 5-year outcomes in this population. METHODS: Patients with chronic or acute coronary syndrome were categorized into high platelet reactivity (HPR; &#x2265;252) and non-HPR (<252) groups based on P2Y12 reaction unit values and further stratified by sex. CYP2C19 loss-of-function (LOF) carrier status was included as a covariate in the multivariable Cox regression model. The primary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), and stroke. Secondary endpoints included each component of MACCE and major bleeding. RESULTS: A total of 3,588 patients were analyzed, including 1,248 in the HPR group and 2,340 in the non-HPR group. Among HPR patients, females had a significantly lower rate of MACCE than males (adjusted hazard ratio: 0.437; P = 0.013; P-for-interaction = 0.037). No sex-related differences in outcomes were observed in the non-HPR group. Among females, outcomes did not differ significantly between the HPR and non-HPR groups. Among males, HPR was associated with higher rates of MI and ST compared to non-HPR (P = 0.041 and P = 0.020, respectively). CONCLUSIONS: Female patients with HPR tended to have lower ischemic event rates than males, without an increase in bleeding events; however, this finding should be interpreted as hypothesis-generating. PTRG-DES Consortium (PTRG), ClinicalTrial.gov Identifier: NCT04734028, URL:https://clinicaltrials.gov/study/NCT04734028. Copyright © 2025 Hellenic Society of Cardiology. Publishing services by Elsevier Inc. All rights reserved.

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