Gender-Based Differences in Clinical Profile and Outcome of Primary Percutaneous Coronary Intervention in Patients With St-Segment Elevation Myocardial Infarction

Abstract

Objectives: A conflict of evidence exists regarding the gender-based differences in outcomes after primary percutaneous coronary intervention (PCI), therefore, aim of this study was to compare the clinical characteristics, angiographic findings, and outcome of primary PCI for men and women. Methodology: Data for this study was extracted from a prospectively managed primary PCI database of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. We included consecutive patients of either gender with STEMI undergone primary PCI. Data on clinical characteristics, angiographic finding, and post procedure outcomes for female were compared with male group and also with a propensity matched male cohort. Results: A total of 2400 patients were included with 421(17.5%) women. The mean age for the men and women were 54.44±11.16 and 57.17±11.01 years respectively; p<0.001. Women had significantly high prevalence of hypertension (61.0% vs. 39.1%; p<0.001), diabetes (37.1% vs. 23.9%; p<0.001), and obesity (18.5% vs. 13.5%; p=0.008). The median symptom onset to hospital arrival time was 216 [366-124] minutes vs. 180 [310-112] minutes; p=0.001 for women and men. In-hospital mortality rate was 3.8% vs. 2.5%; p=0.147 for female and unmatched male cohort, while it was 3.6% vs. 3.8%; p=0.855 for female and propensity matched male cohort. Conclusion: Gender-based differences persist in clinical profile of the patients with STEMI. Women are likely to be older in age with more diabetes, hypertension, and obesity. Gender-based difference in outcome of primary PCI is appears to be driven by differences in clinical profile as adjusted outcome is not different for men and women.

The Age Factor in Cardiac Rehabilitation

“…12 The increase in METs after CR was varied in some studies. [13][14][15][16] Regarding gender, this study showed that it does not influence the METs difference after CR, which contradicts previous studies reporting significant differences in METs improvement between men and women after CR following PCI or CABG. [16][17][18][19] The gender role mechanism in METs response after CR is not fully understood, but it suggests that socioeconomic and cultural factors, including disparities in health care access, variations in exercise completion, societal expectations, and lifestyle patterns, can also impact CR outcomes.…”

“…In CR outcomes, both genders have positive results as they both have an increased post-CR METs response 12. The increase in METs after CR was varied in some studies 13-16. Regarding gender, this study showed that it does not influence the METs difference after CR, which contradicts previous studies reporting significant differences in METs improvement between men and women after CR following PCI or CABG 16-19.…”

Modifiable Risk Factors in Diagnosed Cases of Acute ST Elevation Myocardial Infarction in Young Patients Presenting at Tertiary Care Hospital in Peshawar

“…14,16 A distinctive role of gender has been well reported in the literature, it is a common observation that premature CVD or CVD event at young ages is relatively lesser common among females, an average difference of 10 years has been reported in the age of male and female patients at the time of occurrence of event. [17][18][19] Comparatively, female patients were observed to have higher prevalence of conventional CVD risk factors such as hypertensive, diabetic, and obese, frequent late presentation after symptom onset, and higher angiographic finding of three vessel disease. 16,17 All of these factors have contributed to the prognostic role of female gender with an increased risk of adverse outcomes after coronary intervention.…”

“…[17][18][19] Comparatively, female patients were observed to have higher prevalence of conventional CVD risk factors such as hypertensive, diabetic, and obese, frequent late presentation after symptom onset, and higher angiographic finding of three vessel disease. 16,17 All of these factors have contributed to the prognostic role of female gender with an increased risk of adverse outcomes after coronary intervention. [16][17][18][19][20][21][22] Converse to the local norms, an equal proportion of smoking among females as male counterparts in this particular population can be attributed to the cultural acceptability of domestic use of huqqa in this population.…”

“…16,17 All of these factors have contributed to the prognostic role of female gender with an increased risk of adverse outcomes after coronary intervention. [16][17][18][19][20][21][22] Converse to the local norms, an equal proportion of smoking among females as male counterparts in this particular population can be attributed to the cultural acceptability of domestic use of huqqa in this population.…”