Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

Abstract

on behalf of the Zwolle myocardial infarction study group Abstract Aim: Poorer outcomes in women with ST-elevation myocardial infarction (STEMI) are often attributed to gender differences in baseline characteristics. However, these may be age dependent. We examined the importance of gender in separate age groups of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods and results: Data of 6746 consecutive patients with STEMI admitted for PPCI between 1998 and 2008 in our hospital were evaluated. Age was stratified into two groups, <65 years (young group) and ≥65 years (elderly). Endpoints were enzymic infarct size as well as 30-day and 1 year mortality. We studied a total of 4991 (74.0%) men and 1755 (26.0%) women; 40% of women were <65 years and 60% of men were <65 years of age. In the elderly group (≥65 years), women had more frequently diabetes and hypertension while they smoked less frequently than men. Younger women smoked more often than similarly aged men and had more hypertension. At angiography, single-vessel disease and TIMI 3 flow before PPCI was more present in younger women than men, whereas these differences were not found in the older age group. Patient delay before admission was shorter in men at all ages, while women had lower creatine kinase levels. Younger women had a higher mortality after 30 days (HR 2.1, 95% CI 1.3−3.4) and at 1 year (HR 1.7, 95% CI 1.2−2.6), whereas in the older age group women mortality rates were higher at 30 days (HR 1.5, 95% CI 1.1−2.0) but not at 1 year (HR 1.2, 95% CI 0.9−1.5). After multivariate analysis, 1-year mortality remained significantly higher in women at younger age (HR 1.7, 95% CI 1.1−2.5). Patient delay before admission was shorter in men in both age groups. Creatine kinase levels were in both age groups higher in men. Conclusions: Differences in mortality between men and women with STEMI treated with PPCI are age dependent. Although young women have less obstructive coronary artery disease and more often TIMI 3 flow before PCI (suggesting a lower risk), survival was worse compared to similarly aged men. Women had a longer patient delay compared to men, but this was not related to gender-specific mortality.

Thrombophilia genetic testing in Romanian young women with acute thrombotic events: role of Factor V Leiden, Prothrombin G20210A, MTHFR C677T and A1298C polymorphisms / Evaluarea genetică a trombofiliilor la femei tinere din România cu evenimente acute trombotice: rolul Factorului V Leiden, Protrombinei G20210A, polimorfismelor MTHFR C677T și A1298C

“…In our study, young women seem to be more prone to VTE while men present more frequently with ATE, in agreement with previously reported data in which, at a younger age, there is an overwhelming male majority in patients with acute myocardial infarction (MI) (22). Moreover, premenopausal women have a much lower incidence of heart disease compared to men of the same age explained mostly by the hormonal profile (23).…”

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

“…(16) The mean times investigated showed delay in the access to health services, mainly for women, which remains long. (6) Women may underestimate the risk of heart disease (17) and experience symptoms that are not always typical of the disease, (18) reasons that contribute to a greater delay.…”

Menopause Status and Percutaneous Coronary Intervention

“…Funakoshi et al 12 evaluated Japanese patients (2845 women and 6843 men undergoing first coronary revascularization; PCI or coronary artery bypass grafting) and found that the coronary risk factor burden appeared greater in women than in men, despite the fact that women had a lower incidence of repeated revascularization compared with men. Otten et al 13 studied 4991 men and 1755 women admitted to the hospital for PCI. Patients were stratified into 2 groups, <65 years (young group) and 65 years (elderly).…”