Gender Related Survival Differences in ST-Elevation Myocardial Infarction Patients Treated with Primary PCI

Abstract

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.

Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention

“…The 24 studies (n = 430,914) [ 5 , 10 , 12 , 14 , 18 , 19 , 21 , 22 , 24 – 28 , 30 , 32 , 35 , 37 , 39 , 40 , 41 , 43 , 44 , 51 , 52 ] reported on PCI postoperative in-hospital mortality, which show that the in-hospital mortality of male patients was significantly lower than that of females (OR 0.58, 95% CI 0.52–0.63, P < .001, I 2 = 66%) (Fig. 1 ).…”

“…1 ). This gender differences also reflect in 30-day mortality [OR 0.64, 95% CI 0.61–0.66, P = .04, I 2 = 40%; 19 studies (n = 523,304)], [ 2 – 4 , 7 , 8 , 13 – 17 , 23 , 25 , 26 , 33 – 36 , 42 , 53 ] 1-year mortality [OR 0.67, 95% CI 0.60–0.75, P < .001, I 2 = 73%; 20 studies (n = 590,590)] [ 8 , 10 , 13 , 15 – 17 , 20 , 25 , 26 , 28 , 30 , 33 , 35 , 36 , 38 , 43 , 44 , 53 – 55 ] and >2-years mortality [OR 0.71, 95% CI 0.63–0.79, P = .005, I 2 = 57%; 14 studies (n = 43,096)] [ 4 – 6 , 18 , 19 , 23 , 29 , 31 , 34 , 36 , 40 , 43 , 52 , 56 ] (Figs. 2 – 4 ).…”

“…[ 2 – 44 ] Some studies have showed persistent gender difference in outcomes after adjusting multivariate factors, [ 2 , 5 , 7 , 9 , 10 , 13 , 15 , 18 , 20 – 25 , 28 , 30 – 33 , 35 – 39 , 41 – 43 ] while other studies also demonstrated that gender was not an independent factor for patient's outcome. [ 3 , 4 , 11 , 12 , 14 , 17 , 19 , 26 , 27 , 29 , 34 , 40 , 44 ] Although previous meta-analysis has demonstrated the effect of gender on response to PCI, which not involved major adverse cardiovascular events (MACE) and revascularization, and the follow-up period was also comparatively short. [ 45 – 48 ] Therefore, this meta-analysis was designed to determine the gender difference in patients with coronary artery disease after PCI, and provide evidence for the development of the guideline.…”

Predictors of subsequent myocardial infarction, stroke, and death in stable post-myocardial infarction patients: A nationwide cohort study

“…The majority of studies have reported a higher unadjusted women’s long-term mortality in AMI patients, whether they were ST-elevation MI patients undergoing PCI or non-ST-elevation MI patients. 20–24 However, no gender differences in mortality persisted after adjustment in all except one study, where the difference persisted only in patients younger than 65 years. 22 In the present study, the female stable post-MI patients were older, had more comorbidities such as diabetes, hypertension, prior stroke, atrial fibrillation, CAD, and CKD, but were less invasively treated during the index MI, as compared with the male population.…”

Lokasi Infark Memengaruhi Kejadian Kardiovaskular Mayor Pasien IMA-EST yang Menjalani Late Intervensi Koroner Perkutan

“…Hal ini dikaitkan dengan perempuan cenderung memiliki gejala atipikal sehingga mereka mungkin kurang untuk mencari perawatan ke rumah sakit dan kurang mendapat pengobatan yang optimal. 15,16 Selain itu, pasien perempuan yang menjalani IKP sering berusia lebih tua dan memiliki lebih banyak komorbid. 14 Penelitian ini tidak menemukan adanya perbedaan yang bermakna antara riwayat hipertensi (p=0,462) dan riwayat diabetes melitus (p=0,453) dengan KKM.…”