Gender-related difference in ST-elevation myocardial infarction treated with primary angioplasty: a single-centre
Serafina Valente1, Chiara Lazzeri, Marco Chiostri
1Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, Florence, Italy. seravalente@hotmail.com
Insights
Women with ST-elevation myocardial infarction (STEMI) have a different risk profile and metabolic response, leading to higher mortality rates. These findings suggest a need for more intensive care for female STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Sex Differences in Medicine
Background:
- Data on sex-specific outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) remain inconsistent.
- Understanding these differences is crucial for optimizing treatment strategies and improving patient outcomes.
Purpose of the Study:
- To investigate sex-related differences in the management and early outcomes of STEMI patients treated with PCI.
- To identify specific risk factors and physiological responses that may contribute to differential outcomes between men and women.
Main Methods:
- A consecutive series of 1127 STEMI patients undergoing PCI were analyzed.
- Data collected included patient demographics, comorbidities, management strategies, door-to-balloon times, and in-intensive cardiac care unit (ICCU) outcomes.
- Statistical analysis was performed to identify significant sex-related differences.
Main Results:
- Female STEMI patients were older, more hypertensive, diabetic, and had higher incidences of neurological impairment and COPD.
- Females experienced longer door-to-balloon times, higher rates of major bleeding, and increased in-ICCU mortality.
- Biomarker analysis revealed higher admission and peak glucose, fibrinogen, and erythrocyte sedimentation rates, alongside lower estimated glomerular filtration rate (eGFR) and hemoglobin levels in women.
Conclusions:
- STEMI women present with a distinct risk profile, including older age, more comorbidities, and lower hemoglobin levels.
- Gender-specific metabolic and inflammatory responses to acute myocardial ischemia contribute to poorer outcomes in women.
- The findings underscore the need for more intensive care in women with STEMI, addressing their more severe hemodynamic derangement and metabolic impairment.
Objective:
Still contrasting are data on the impact of sex on outcome in patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).
Design:
We sought sex-related differences in management and early outcomes in 1127 STEMI patients submitted to PCI consecutively admitted to our intensive cardiac care unit (ICCU) in Florence from 1 January 2004 to 31 December 2009.
Results:
Females were significantly older, leaner (p < 0.001, respectively), more hypertensive (p < 0.001), and diabetic (p = 0.016); they showed a higher incidence of neurological impairment (p = 0.002) and chronic obstructive pulmonary disease (p = 0.048). Higher Killip classes were more frequent in females (p = 0.015). Door-to-balloon time was higher in females (p < 0.001) who showed a higher incidence of major bleeding (p < 0.001) and a higher in-ICCU mortality rate (p = 0.037). The use of IIbIIIa glycoprotein inhibitors was lower in females (p < 0.001) who exhibited higher values of admission glycaemia and peak glycaemia (p < 0.001 and p < 0.001, respectively), higher values of fibrinogen (p < 0.001) and erythrocyte sedimentation rate (p < 0.001), and lower eGFR and haemoglobin values (p < 0.001).
Conclusions:
According to our data, STEMI women show not only a different risk profile (older age, comorbidities, lower haemoglobin values), but also a different gender-related metabolic and inflammatory responses to acute myocardial ischaemia in respect to men. All these factors can account for the higher in-ICCU mortality in women and strongly suggest that STEMI women deserve more intensive care due to a more severe haemodynamic derangement (as indicated by the higher use of inotropes, diuretics, and non-invasive ventilation) and to a more serious metabolic impairment (as inferred by higher glucose values).
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