Sex-Based Outcomes in Patients With a High Bleeding Risk After Percutaneous Coronary Intervention and 1-Month Dual Antiplatelet Therapy

Abstract

Compared with men, women typically present with a higher risk of adverse outcomes after percutaneous coronary intervention (PCI) attributed to advanced age and greater comorbidities.^1-3 In particular, women are at high risk for bleeding events after PCI^1,2 and, consequently, may be undertreated with PCI⁴ or may be preferentially treated with a bare-metal stent (BMS) rather than a drug-eluting stent (DES),⁵ although BMS use is declining. Studies have shown that women are less likely to receive dual antiplatelet therapy (DAPT),⁶ potent antiplatelet therapy,^1,3 or other secondary prevention medications.⁷ For women, these risk-treatment biases may result in not only being denied the benefits of DES PCI⁵ but also having higher subsequent hospitalization rates with angina.⁸ Compared with BMS, DES substantially reduces the risk of target lesion revascularization (TLR), but new-generation, polymer-free drug-coated stents (DCS) have been designed to accelerate healing and to mitigate the risk of stent thrombosis (ST) attributed to polymer hypersensitivity with durable polymer DES.^9-11 The LEADERS FREE trial was the first randomized clinical trial (RCT) to demonstrate the long-term efficacy and safety of a biolimus A9-eluting DCS (BioFreedom; Biosensors International) compared with a BMS with 1 month of DAPT in patients with a high bleeding risk.^12-14