Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study trial.

We assessed the relation between female sex and sirolimus-eluting stent (SES) use on long-term outcomes in acute myocardial infarction.There are no data on sex-specific differences in long-term benefit of SES use compared with bare-metal stent (BMS) use among patients undergoing primary percutaneous coronary interventions.We performed a post hoc analysis of the MULTISTRATEGY trial. Hazard ratios (HRs) of events with 95\% CI for sex and stent type were computed using Cox proportional regression with adjustment for confounders.A total of 744 patients, 64 years old (55-73 years old), 179 (24.1\%) women, were enrolled. After a follow-up of 1,080 days, SES use was associated with a significant reduction of major adverse cardiovascular events, that is, the composite of all-cause death, reinfarction, or clinically driven target vessel revascularization (TVR) (13.9\% vs 23.6\%, adjusted HR 0.62, 95\% CI 0.41-0.94, P = .026) and of TVR (6.1\% vs 15.1\%, adjusted HR 0.35, 95\% CI 0.19-0.63, P < .001) in men. Conversely, SES use was not associated to a better outcome among women (major adverse cardiovascular events 21.9\% in SES vs 18.2\% in the BMS group, adjusted HR 1.27, 95\% CI 0.53-3.02, P = .59; TVR 6.6\% vs 9.1\%, adjusted HR 0.62, 95\% CI 0.17-2.21, P = .46).In this analysis, the clinical benefit of SES use, over BMS, at 3-year follow-up was restricted to men and was not observed among women.