Effect of stent diameter in women undergoing percutaneous coronary intervention with early- and new-generation drug-eluting stents: From the WIN-DES collaboration

Background: The risk of stent thrombosis (ST)or target lesion revascularization (TLR)is increased with smaller stent diameters (SD). Whether SD has a deleterious effect in women treated with early- vs. new-generation drug-eluting stents (DES)is unknown. Methods: We pooled patient-level data from 26 randomized control trials of DES. Only women treated with DES were included. Subjects were stratified according to SD: small, SD ≤ 2.75 mm; intermediate, 2.75 mm < SD ≤ 3.25 mm; and large, SD ≥ 3.25 mm. Endpoints of interest were 3-year definite ST, TLR, major adverse cardiac events (MACE: the composite of death, myocardial infarction or TLR)and death. Results: Of 6413 women, 2274 (35.0%)had a small SD, 2448 (38.0%)had an intermediate SD, and 1691 (26.0%)had a large SD. By multivariable analysis, stent diameter (per 0.25 mm decrease)was associated with an increased risk of TLR and ST, which was uniform in terms of magnitude and direction between early- and new-generation DES. There were no differences in MACE or death across groups. Conclusion: Small SD in women undergoing PCI is associated with an increased risk of definite ST and TLR, consistently with both early- and new-generation DES.