Gender disparity in 48-hour mortality is limited to emergency percutaneous coronary intervention for ST-elevation
Jérôme Roncalli1, Meyer Elbaz, Nicolas Dumonteil
1Department of Cardiology, Rangueil University Hospital, Toulouse, France. roncalli.j@chu-toulouse.fr
Insights
Elderly women face higher mortality after emergency percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). No gender differences were observed in younger patients or those undergoing non-emergency procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Disparities
Background:
- Acute coronary syndromes (ACS) exhibit higher mortality in women compared to men.
- This disparity is particularly pronounced when interventional strategies are employed.
Purpose of the Study:
- To investigate gender-based differences in in-hospital mortality within 48 hours.
- Focus on emergency percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) and non-emergency PCI.
Main Methods:
- Analysis of over 9000 patients undergoing PCI between January 2005 and June 2008.
- Primary endpoint: 48-hour mortality post-PCI. Secondary endpoints included recurrent MI, re-intervention, stroke, and complications.
- Logistic regression and propensity-score matching were utilized for data analysis.
Main Results:
- In emergency PCI-STEMI (n=1753), 48-hour mortality was 4.9% in women vs. 2.2% in men (p=0.004).
- Gender disparity in mortality was significant only in patients aged ≥75 years (8.1% in women vs. 3.3% in men, p=0.02).
- No significant gender differences in mortality or secondary endpoints were found in the non-emergency PCI group (n=7336).
Conclusions:
- Elderly women (≥75 years) experience disproportionately higher in-hospital mortality post-emergency PCI for STEMI.
- No significant gender-based mortality differences were observed in younger patients or those undergoing non-emergency PCI procedures.
Background:
Previous studies indicate that mortality from acute coronary syndromes is higher in women than in men, especially in case of interventional strategy.
Aim:
To assess whether the in-hospital mortality rate differs between genders during the first 48h after emergency percutaneous coronary intervention for ST-elevation myocardial infarction (emergency PCI-STEMI) or after non-emergency PCI.
Methods:
All patients treated with PCI between January 2005 and June 2008 were included. The primary endpoint was frequency of death within 48h after the PCI procedure; secondary endpoints included frequency of recurrent myocardial infarction, new PCI or coronary artery bypass graft surgery, stroke, and major vascular or renal complications. Data were analysed via logistic regression with and without propensity-score matching.
Results:
More than 9000 patients underwent PCI. In the emergency PCI-STEMI group (n=1753), 48-hour mortality occurred in 2.2% of men and 4.9% of women (p=0.004). However, gender disparity occurred only in elderly patients; the rate was significantly (p=0.02) higher in women (8.1%) than in men (3.3%) aged > or =75 years. There was no evidence of gender disparity in the non-emergency PCI group (n=7336) or in secondary endpoints for either PCI group. Similar results were obtained in pair analyses of men and women with matching propensity scores.
Conclusions:
Elderly women have a disproportionately high in-hospital mortality rate during the first 48h after emergency PCI for treatment of STEMI; however, there is no gender discrepancy in younger patients or patients of any age who receive non-emergency procedures.
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