Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Arch Cardiovasc Dis. Aug-Sep 2015;108(8-9):428-36. doi: 10.1016/j.acvd.2015.03.002. Epub 2015 Apr 27.

Abstract

Background: Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial.

Aim: To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes.

Methods: Consecutive women with STEMI of<24 hours' duration referred (August 2007 to January 2011) for primary PCI were compared with men matched for age and diabetes. Rates of all-cause mortality, target vessel revascularization (TVR) and major cardiovascular and cerebrovascular events (MACCE) (death/myocardial infarction/stroke) were assessed at 1 year.

Results: Among 775 consecutive patients, 182 (23.5%) women were compared with 182 matched men. Mean age was 69±15 years, 18% had diabetes. Patient characteristics were similar, except for lower creatinine clearance (73±41 vs 82±38 μmol/L; P=0.041), more cardiogenic shock (14.8% vs 6.6%; P=0.017) and less radial PCI (81.3% vs 90.1%; P=0.024) in women. Rates of 1-year death (22.7% vs 18.1%), TVR (8.3% vs 6.0%) and MACCE (24.3% vs 20.9%) were not statistically different in women (P>0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55-1.87; P=0.97).

Conclusion: In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline.

Keywords: Angioplastie coronaire; Coronary angioplasty; Femme; Infarctus du myocarde; Myocardial infarction; Sex; Sexe; Women.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • France
  • Health Status Disparities*
  • Hospital Mortality
  • Hospitals, High-Volume
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Odds Ratio
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / mortality
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Treatment Outcome