Gender-based differences in long-term outcome after ST-elevation myocardial infarction in patients treated with
Alexander Bufe1, Judith Wolfertz, Wilfried Dinh
1Helios Clinic Wuppertal, Heart Center, Department of Cardiology, Wuppertal, Germany. alexander.bufe@helios-kliniken.de
Insights
Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) shows no long-term outcome differences between men and women. This effective treatment benefits women with acute myocardial infarction, offering comparable long-term results to men.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Historically, women faced higher mortality rates than men after acute ST-elevation myocardial infarction (STEMI) during the fibrinolysis era.
- Primary percutaneous coronary intervention (PCI) is the leading therapy for STEMI.
- The impact of female gender on long-term prognosis following systematic PCI treatment for STEMI remains unclear.
Purpose of the Study:
- To investigate whether female gender independently predicts a worse long-term prognosis in STEMI patients treated with PCI.
- To compare the long-term outcomes of women and men undergoing PCI for STEMI.
Main Methods:
- A cohort of 500 consecutive STEMI patients treated with PCI between 1999 and 2001 at Wuppertal Heart Centre.
- Long-term follow-up, up to 7 years, was successfully achieved in 97% of patients.
- Statistical analysis, including stepwise regression, was employed to identify predictors of mortality.
Main Results:
- Women were older and had a higher prevalence of diabetes mellitus compared to men.
- No significant differences were observed in 30-day mortality, late cardiac mortality, or overall long-term cardiac mortality up to 7 years between genders.
- Female gender was not identified as an independent predictor of late mortality, and quality of life was comparable.
Conclusions:
- Systematic PCI treatment for STEMI eliminates gender-related differences in long-term outcomes.
- PCI demonstrates a sustained positive effect for women with STEMI.
- PCI should be considered the preferred treatment strategy for women experiencing acute myocardial infarction.
Background:
In the era of fibrinolysis, women suffered from higher early and late mortality rates than men after acute ST-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) has been determined to be the most effective therapy strategy in STEMI. It is not clear if female gender is an independent predictor of a worse long-term prognosis among patients who were systematically treated with PCI. We, therefore, examined the effect of PCI on long-term outcome between women and men.
Methods:
Between 1999 and 2001, 500 consecutive patients at the Wuppertal Heart Centre were treated with PCI after acute STEMI. A long-term follow-up (up to 7 years) was achieved in 97% of the patients.
Results:
In comparison to men, women were 7 years older (65 +/- 12 vs. 58 +/- 11) and had significantly more diabetes mellitus. The time between onset of symptoms and intervention tended to be longer in women than men. There was no difference in 30-day mortality (8.9% vs. 6.6%), cardiac late mortality (3.6% vs. 3.2%), and long-term cardiac overall mortality up to 7 years (12.1% vs. 9.6%). Stepwise regression analysis did not identify female gender as an independent predictor of late mortality. The quality of life was comparable.
Conclusions:
There was no gender-related difference in the long-term outcome if patients were sytematically treated with PCI in STEMI. PCI in STEMI has a long-lasting positive effect in women and should, therefore, be considered the treatment of choice for women with acute myocardial infarction.
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