[Therapeutic approach and mortality in men and women with ST-segment elevation myocardial infarction]
Insights
Immediate reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) offers the best outcomes. Primary percutaneous intervention (pPCI) proved most beneficial, though women consistently faced worse prognoses across all treatment strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Context:
- ST-segment elevation myocardial infarction (STEMI) treatment outcomes are critical.
- A significant percentage of STEMI patients do not receive recommended reperfusion therapy.
- Understanding the impact of different therapeutic approaches on STEMI prognosis is essential.
Purpose:
- To analyze the impact of various therapeutic strategies on patient prognosis following the acute phase of STEMI.
- To compare outcomes across different treatment modalities, including primary percutaneous intervention (pPCI), fibrinolysis, conservative management, and surgery.
- To investigate potential sex-based differences in treatment outcomes for STEMI patients.
Summary:
- A large registry study of 26,035 STEMI patients revealed that primary percutaneous intervention (pPCI) yielded the best patient outcomes.
- All treatment strategies, including conservative, fibrinolytic, and interventional approaches, showed worse 12-month mortality rates in women compared to men.
- Surgical treatment outcomes showed no significant difference in mortality between men and women.
Impact:
- Primary percutaneous intervention (pPCI) is identified as the most beneficial therapeutic strategy for STEMI patients.
- The findings highlight a significant disparity in STEMI outcomes for women, necessitating further investigation and tailored treatment approaches.
- This analysis provides crucial data for optimizing STEMI management protocols and improving patient prognosis, particularly for female patients.
Unlabelled:
The benefit of immediate reperfusion in the treatment of ST-segment elevation myocardial infarction (STEMI) is indisputable. Unfortunately, no reperfusion therapy is applied to nearly 30% of patients without contraindication to such treatment. We aimed to analyze the impact of therapeutic approach on the prognosis after acute phase of STEMI.
Material And Methods:
The study group consisted of 26035 consecutive STEMI patients (8989 females, 34.4%) hopitalized in 456 sites during one year. Data were available from the Polish Registry of Acute Coronary Syndromes (PL-ACS) launched in Silesian Center for Heart Diseases, Zabrze.
Results:
Patiens treated with primary percutaneous intervention (pPCI) had the best outcome. All therapeutic strategies resulted in worse prognosis in women when compared to men. Women had greater 12-month mortality in the conservative, fibrinolytic and interventional treatment group: 33.1% vs 23.2%; p < 0.0001; 24.3% vs 16.2%; p < 0.0001 i 11.4% vs 8.2%, p < 0.0001, respectively. Differences in the surgically treated group were insignificant (men: 25%, women: 8%, p = 0.42).
Conclusions:
The outcome of conservative, fibrinolytic and interventional treatment was worse in the female group. Primary coronary angioplasty was the most benefical therapeutic strategy.
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