CORRESPONDENCE: LETTERS TO THE EDITOR
Is aspirin resistance or female gender associated with a high incidence of myonecrosis after nonurgent percutaneous coronary intervention?
Tina S. Poulsen, MD*,
Anders Kastrup, MD and
Hans Mickley, MD, PhD
* Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark (Email: tina.poulsen{at}ouh.fyns-amt.dk).
We have with great interest read the report by Chen et al. (1) published in the March 17 issue of the Journal. The prevalence of aspirin resistance among patients with different manifestations of atherosclerosis has been well established. However, studies addressing the clinical relevance of aspirin resistance are still lacking. Therefore, studies as the one performed by Chen et al. (1) should be appreciated.
To understand the clinical importance of the results presented, however, we will take this opportunity to ask the investigators whether the gender of the patients was included in the multivariate analysis identifying independent predictors of creatine kinase-myocardial band (CK-MB) elevation after percutaneous coronary intervention (PCI)?
Female gender has been proposed to be a risk factor for mortality and morbidity in relation to the performance of PCI (2,3). This observation has been partly explained by older age, more severe heart failure, an increased prevalence of co-morbidity, and the presence of smaller coronary arteries in women compared with men.
Chen et al. (1) showed that aspirin resistance is significantly more prevalent in female (44.8%) than in male patients (19.7%). This difference between genders in the occurrence of aspirin resistance may in part account for the observed increased risk for experiencing complications in relation to the PCI procedure (1). Unfortunately, from the data presented it is not possible to decide whether gender was included in the multivariate analysis. To put the results of the study by Chen et al. (1) into an appropriate clinical perspective, we would like the investigators to inform us—and other readers—whether gender independently influenced clinical outcome.
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References
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1. Chen WH, Lee PY, Ng W, et al. Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment J Am Coll Cardiol 2004;43:1122-1126.[Abstract/Free Full Text]
2. King KM, Ghali WA, Faris PD, et al. Sex differences in outcomes after cardiac catherizationEffect modification by treatment strategy and time. JAMA 2004;291:1220-1225.[Abstract/Free Full Text]
3. Vaccarino V, Abramson JL, Veledar E, et al. Sex-based differences in early mortality after myocardial infarction N Engl J Med 1999;341:217-225.[Abstract/Free Full Text]
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