P6077Gender-related differences in short and long-term all-cause mortality in unselected patients undergoing primary percutaneous coronary intervention

Abstract

Background: Primary percutaneous coronary intervention (PCI) improved prognosis of patients with acute ST-elevation myocardial infarction (STEMI). However, studies have shown sex-based disparities in outcomes after primary PCI. Purpose: This study sought to investigate the influence of gender on short and long-term mortality in unselected STEMI patients treated with primary PCI. Methods: Data of all consecutive STEMI patients admitted for primary PCI between 8/2009 and 12/2012, enrolled in a prospective registry of a high volume tertiary centre, were analyzed. In-hospital bleeding was assessed using Bleeding Academic Research Consortium (BARC) criteria. The primary outcomes were 30-day, 1-year, and 4-year all cause mortality. Results: Of the 3034 consecutive STEMI patients underwent emergency coronary angiography, 2715 were treated with primary PCI, of whom 807 (29.7%) were female. In comparison to men, women were significantly older, with higher prevalence of diabetes, hypertension and hypercholesterolemia. Women also showed higher incidence of Killip class II-IV, renal insufficiency and anaemia at admission, and higher rates of in-hospital BARC type ≥2 bleeding (11.9% vs. 3.9%, p<0.001). Compared with man, women had significantly higher rates of 30-day (9.4% vs. 5.2%; p<0.001), 1-year (16.0% vs. 9.8%; p<0.001) and 4-year (21.6% vs. 15.7%; p<0.001) all-cause mortality. Kaplan-Meier curves for 4-year survival are shown in Figure. However, after adjusting baseline differences using multivariate analysis, female sex was not an independent predictor of mortality at 30-days (HR 1.08, 95% CI 0.74-1.56; p=0.692) as well as at 1-year (HR 1.05, 95% CI 0.80-1.38; p=0.704) and at 4-years (HR 0.87, 95% CI 0.70-1.08; p=0.214) follow up. Kaplan-Meier curves for 4-year survivalConclusion: This study found that women treated with primary PCI had higher risk profile, more co-morbidity and were at increased risk of bleeding as compared to men. However, female gender was not an independent predictor of short and long-term mortality. Background: The role of antiplatelet treatment before emergent revascularization is controversial as well as routine manual thrombectomy although both strategies can improve angiographic results. The aim of our study was testing the impact of pre-treatment on manual thrombectomy results. Methods: Observational and prospective study of all consecutive patients referred for emergent angiography in a single centre between February and December 2016. TIMI flow-3 after thrombectomy or angioplasty were considered as successful result. Pre-treatment was collected from medical reports as considered when it was administered before patient arrived to the cath-lab. Results: 286 patients were included, mean age 63.7 (13.2) age and 79.3% males. Median (IQ ranges) time delays were: symptoms to first medical contact 75 (32.25) minutes; first-medical contact to system activation 34,5 (20-60); arrival to hospital admission 50 (26-72); door-to-angioplasty 20 (15-25). Pre-treatment was administered in 226 (79.0%) patien...