Elsevier

Canadian Journal of Cardiology

Volume 27, Issue 6, November–December 2011, Pages 749-755
Canadian Journal of Cardiology

Clinical research
Impact of Female Sex on Long-Term Outcomes in Patients With ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

https://doi.org/10.1016/j.cjca.2011.07.002Get rights and content

Abstract

Background

Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI).

Methods

This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95% confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men.

Results

Among 481 patients, median age 66 years old, 138 (28.7%) were women. Women were older than men (72 vs 63 years, P < 0.001), had a higher prevalence of hypertension (68% vs 54%, P = 0.006), diabetes (27% vs 19%, P = 0.04), and Killip class ≥ 3 at admission (19% vs 10%, P = 0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9% vs 18.4%, unadjusted HR 1.86; 95% CI, 1.26-2.74; P = 0.002), driven mainly by heart failure (unadjusted HR 2.47; 95% CI, 1.12-5.41; P = 0.024), without significant differences in death (unadjusted HR 1.49; 95% CI, 0.88-2.53; P = 0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95% CI, 0.78-3.27; P = 0.19) and no increase in target lesion revascularization (9.4% vs 12.5%, unadjusted HR 0.77; 95% CI, 0.42-1.44; P = 0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95% CI, 0.84-2.06; P = 0.23).

Conclusions

Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.

Résumé

Introduction

Des informations contradictoires existent au sujet des différences sexuelles qui nuiraient aux résultats à long terme des patients subissant une intervention coronarienne percutanée (ICP) primaire.

Méthodes

Dans cette étude rétrospective, des patients consécutifs présentant un infarctus du myocarde avec sus-décalage du segment ST subissant une ICP primaire dans les 24 heures à la suite de l'apparition des symptômes ont été inscrits. Les rapports de risque (RR) d'événements avec un intervalle de confiance (IC) de 95 % ont été calculés pour l'ensemble de la population et pour une cohorte appariée de femmes et d'hommes selon le score de propension.

Résultats

Parmi 481 patients d'âge médian de 66 ans, 138 (28,7 %) sont des femmes. Les femmes sont plus âgées que les hommes (72 vs 63 ans, P < 0,001), ont une prévalence plus élevée d'hypertension (68 % vs 54 %, P = 0,006), de diabète (27 % vs 19 %, P = 0,04) et une classification de Killip ≥ 3 à l'admission (19 % vs 10 %, P = 0,007). Après un suivi médian de 1041 jours, les femmes ont expérimenté une incidence significative plus élevée du critère composite associant la mort, l'infarctus du myocarde non fatal et l'hospitalisation pour une insuffisance cardiaque (31,9 % vs 18,4 %, RR non ajusté 1,86; IC de 95 %, 1,26-2,74; P = 0,002), causée principalement par l'insuffisance cardiaque (RR non ajusté 2,47; IC de 95 %, 1,12-5,41; P = 0,024), sans différence significative sur le décès (RR non ajusté 1,49; IC de 95 %, 0,88-2,53; P = 0,13), ou un infarctus du myocarde non fatal (RR non ajusté 1,59; IC de 95 %, 0,78-3,27; P = 0,19) et aucune augmentation dans la revascularisation de la lésion cible (9,4 % vs 12,5 %, RR non ajusté 0,77; IC de 95 %, 0,42-1,44; P = 0,42). Après l'appariement du score de propension, le risque du critère composite a été grandement atténué (RR 1,32; IC de 95 %, 0,84-2, 06; P = 0,23).

Conclusions

Les femmes subissant une ICP primaire expérimentent des résultats à long terme pires que les hommes, mais cette différence est grandement expliquée par leur profil cardiovasculaire de base plus défavorable.

Section snippets

Population and design

This is a single centre retrospective observational study performed at 1 tertiary cardiac centre enrolling consecutive patients admitted with a diagnosis of ST-elevation acute MI (STEMI), undergoing primary PCI within 24 hours from symptom onset between 2004 and 2008. The diagnosis of STEMI was based on typical symptoms and new ST-segment elevation at the J point in > 2 contiguous leads (> 0.2 mV in V1 through V3 and > 0.1 mV in other leads). No exclusion criteria were applied. Coronary

Patient baseline characteristics

A total of 481 patients, 65.6 (56.1-73.7) years old, 138 (28.7%) women, entered the study. Baseline clinical and procedural characteristics in the overall population and according to gender are reported in Table 1. Briefly, the prevalence of multivessel disease was > 50%, the use of intraprocedural IIb-IIIa inhibitors was large (80.5%), manual thrombus aspiration was performed in 30% of patients. Women were significantly older than men, had a higher prevalence of hypertension and of diabetes,

Discussion

This observational study reports long-term clinical outcomes according to sex of an unselected population of consecutive patients with STEMI undergoing primary PCI within 24 hours from symptom onset. The main findings are as follows: (1) women experience a significant higher incidence of the composite of death, nonfatal MI and hospitalization for heart failure, driven mainly by a significant increase of hospitalization for heart failure at long term follow-up, with no increase in TLR; (2) women

Funding Sources

This study was supported by a grant from the Italian Ministry of Health.

Disclosures

The authors have no conflicts of interest to disclose.

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