Gender-related differences in men and women with ST-segment elevation myocardial infarction and incomplete infarct-related artery flow restoration: a multicenter national registry

Abstract

IntroductionLittle is known about gender-related differences in ST-segment elevation myocardial infarction (STEMI) and incomplete infarct-related artery (IRA) reperfusion after primary percutaneous coronary intervention (pPCI).AimTo evaluate gender-related differences in clinical characteristics and prognosis in patients with STEMI and incomplete IRA reperfusion after pPCI.Material and methodsFrom 42,752 STEMI patients hospitalized between 2009 and 2011 in Poland we analyzed a group of 984 (36%) females and 1,746 (64%) males with less than Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow following pPCI.ResultsWomen were older than men (72.0 ±11.3 vs. 64.0 ±11.7 years; p < 0.0001) and in age-adjusted analysis they were more likely to present with hypertension (73.7% vs. 67%; p = 0.0003), diabetes (33% vs. 22.6%; p < 0.0001) and obesity (28.1% vs. 22.6%; p = 0.0016). Heart rate > 100 beats/min was more common in women, while men were more often smokers and presented with sudden cardiac arrest. The most common IRA in women was the left anterior descending artery, and the right coronary artery in men. After adjusting for age statistically significant differences in pharmacotherapy concerned only the use of insulin (OR = 1.31, 95% CI: 1.02–1.68). High risk of death, rehospitalization due to heart failure or cardiac causes, were observed in all patients during the 6-month and 12-month follow-up periods. The risk of heart failure was significantly higher in women than in men. The most significant decrease in survival rates was observed in the in-hospital period.ConclusionsAmong patients with STEMI and post-interventional TIMI flow grade < 3 women have unfavorable baseline characteristics and an adverse short- and long-term prognosis when compared to men.

Epidemiological Variation of Acute Myocardial Infarction Relevant to In-Hospital Outcomes-Tertiary Center Experience-Saudi Arabia

“…In our study, when comparing the presentation of STEMI in relation to gender, we found that women were elderly, had a significantly higher prevalence of comorbidities (obesity, diabetes mellitus and hypertension) and poor hospital outcomes (higher rates of pulmonary edema, mechanical ventilation and even in-hospital mortality), suggesting a greater severity in the clinical presentation for this group. These findings were similar to different studies from different regions [ 9 – 13 ]. Also a recent study conducted from six Middle Eastern Countries demonstrated that women have almost doubled the number of mortality from STEMI compared with men [ 14 ].…”

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

“…Studies of various nature have also reported the same observation of relatively or significantly higher rate of adverse outcomes among women. 4,5,8,9,12,13,15,22,25 However, differences in outcomes was suspected to be driven by the fact that female patients had more high risk clinical profile as compared to male patients, which included older age, more diabetic, more hypertensive, more obese, and prolonged exposure to the untreated ischemia. Therefore, female patients were compared to the propensity matched cohort of male patients which showed that the apparent difference by gender in in-hospital mortality rate diminished.…”

“…Various studies have found female gender to be associated with a significant increased risk of shortand long-term mortality after acute coronary event. [4][5][6][7][8][9][10][11][12][13] Nonetheless, there exist a conflict of evidence as ample literature also available suggesting either no gender differences in outcomes or attributing differences in outcomes with differences in baseline characteristics or increased burden of comorbidities in women due to relatively older age at presentation. 14,15 Studies reporting gender disparities in outcomes postulated various determinants of higher rate of adverse events in women, some studies argued that the atypical clinical presentation is more common among women also pre-hospital delay is more common for females as compared to their male counterpart resulting in delay in reperfusion therapy.…”

Prognosis of Patients With Cardiogenic Shock Following Acute Myocardial Infarction: The Difference Between ST-Segment Elevation Myocardial Infarction And Non-ST-Segment Elevation Myocardial Infarction

“…15,16 Other studies focusing on STEMI with gender difference have also shown this phenomenon. 17,18 The possible causes include older age and more comorbidities in female patients with ACS. However, a further study on STEMI in younger patients showed worse short-term outcomes in female patients after adjustment for demographics, comorbidities, medications, and severity of coronary disease.…”