Background: Data about gender as an independent risk factor for death in ST-elevation myocardial infarction (STEMI) patients is still contrasting. Aim was to assess how gender influences in-hospital and long-term all-cause mortality in STEMI patients with primary percutaneous coronary intervention (PCI) in our region.Methods: We analysed data from 2069 STEMI patients undergoing primary PCI in our institution from January 2009-December 2014, of whom 28.9% were women. In-hospital and long-term mortality were observed in women and men. The effect of gender on in-hospital mortality was assessed by binary logistic regression modelling and by Cox regression analysis for long-term mortality.Results: Women were older (68.3±61.8 vs 61.8±12.0 years; p<0.0001), with a higher prevalence of diabetes (13.7% vs 9.9%; p=0.013) and tend to be more frequently admitted in cardiogenic shock (8.4% vs 6.3%; p =0.085). They were less frequently treated with bivalirudin (15.9% vs 20.3%; p=0.022).In-hospital mortality was higher among women (14.2% vs 7.8%; p<0.0001). After adjustment, age (adjusted OR: 1.05; 95% CI: 1.03 to 1.08; p < 0.001) and cardiogenic shock at admission (adjusted OR: 24.56; 95% CI: 11.98 to 50.35; p < 0.001), but not sex (adjusted OR: 1.47; 95% CI: 0.80 to 2.71) were identified as prognostic factors of in-hospital mortality.During the median follow-up of 27 months (25th, 75th percentile: 9, 48) the mortality rate (23.6% vs 15.1%; p<0.0001) was significantly higher in women.The multivariate adjusted Cox regression model identified age (HR 1.05; 95% CI 1.04-1.07; p<0.0001), cardiogenic shock at admission (HR 6.09; 95% CI 3.78-9.81; p<0.0001), hypertension (HR 1.49; 95% CI 1.02-2.18; p<0.046), but not sex (HR 1.04; 95% CI 0.74-1.47) as independent prognostic factors of follow-up mortality.Conclusion: Older age and worse clinical presentation rather than gender may explain the higher mortality rate in women with STEMI undergoing primary PCI.

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Older age, comorbidities, worse clinical presentation, and adjunctive pharmacotherapy rather than sex may explain the higher mortality rate in women with MI undergoing PCI.

IntroductionST-Elevation Myocardial Infarction (STEMI) represents a highly pro-thrombotic state with platelets being greatly activated [1,2]. The early and strong platelet inhibition seems to be of paramount importance in patients with STEMI undergoing Percutaneous Coronary Intervention (PCI) [3]. Newer P2Y12 receptor inhibitors prasugrel and ticagrelor (newer P2Y12) exhibit more rapid, potent, and consistent platelet inhibition than clopidogrel and reduce the risk for ischemic cardiovascular complications [4][5][6][7][8][9][10]. In STEMI patients, an initial delay in the onset of newer P2Y12 antiplatelet action was observed and ticagrelor did not appear superior to prasugrel [3]. However, patients with Cardiogenic Shock (CS) or after Cardio Pulmonary Resuscitation (CPR) were mostly excluded from randomized studies and data on the clinical efficacy of these drugs comparing to clopidogrel in these patients is sparse [11][12][13].CS has a profound effect on drug absorption and metabolism due to the disturbance of microcirculation, the use of catecholamines and opioids which results in slower platelet inhibition [13][14][15]. The pharmacological properties of the newer P2Y12 are promising in a CS setting since their bioactivation is more rapid and consistent when compared to clopidogrel [2,13].Mild therapeutic hypothermia leads to a pro-thrombotic milieu per se and activation of the P2Y12 receptor inhibitors (P2Y12) may AbstractBackground: Little is known about clinical efficacy of newer P2Y12 receptor inhibitors in ST-elevation myocardial infarction patients presenting with cardiogenic shock or after cardiopulmonary resuscitation. The aim of our study was to establish the possible role of newer P2Y12 receptor inhibitors prasugrel and ticagrelor on survival in comparison to clopidogrel administration in ST-elevation myocardial infarction patients presenting with cardiogenic shock and / or after cardiopulmonary resuscitation.

DRF identified patients at increased risk of higher long-term mortality but was not independently associated with mortality.

AKI occurs more often in women than men with MI undergoing PCI. Female gender independently predicted AKI in our analysis. A high CV/GFR denotes a group of patients who are at higher risk of AKI after PCI. CV/GFR was significantly higher in women, which may help to explain their worse outcome as regards AKI.