Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation
Olivier Barthélémy1, Philippe Degrell1, Emmanuel Berman1
1Institut de cardiologie (AP-HP), université Paris 6, Pitié-Salpêtrière Hospital, Paris, France.
Insights
Women and men with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) show similar 1-year outcomes. This study found no significant differences in mortality or major adverse events between sexes after PCI for STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Outcomes following percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) may differ between women and men, but this remains controversial.
- Contemporary treatment strategies aim to optimize care for all STEMI patients.
Purpose of the Study:
- To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes.
- To investigate potential sex-based differences in major adverse cardiovascular and cerebrovascular events (MACCE) after STEMI treatment.
Main Methods:
- A comparison of consecutive women with STEMI (<24 hours' duration) undergoing primary PCI with age- and diabetes-matched men.
- Assessment of 1-year rates of all-cause mortality, target vessel revascularization (TVR), and MACCE (death/myocardial infarction/stroke).
Main Results:
- 182 women were matched with 182 men; women had higher rates of cardiogenic shock and lower rates of radial PCI.
- 1-year rates of death (22.7% vs 18.1%), TVR (8.3% vs 6.0%), and MACCE (24.3% vs 20.9%) were not statistically different between sexes.
- After excluding patients with shock or out-of-hospital cardiac arrest, death rates were similar (11.3% vs 11.8%). Female sex was not independently associated with death.
Conclusions:
- In an unselected patient population, women with STEMI treated with primary PCI had similar 1-year outcomes to matched men.
- Despite a higher baseline risk profile, women experienced comparable results to men after contemporary primary PCI for STEMI.
Background:
Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial.
Aim:
To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes.
Methods:
Consecutive women with STEMI of<24 hours' duration referred (August 2007 to January 2011) for primary PCI were compared with men matched for age and diabetes. Rates of all-cause mortality, target vessel revascularization (TVR) and major cardiovascular and cerebrovascular events (MACCE) (death/myocardial infarction/stroke) were assessed at 1 year.
Results:
Among 775 consecutive patients, 182 (23.5%) women were compared with 182 matched men. Mean age was 69±15 years, 18% had diabetes. Patient characteristics were similar, except for lower creatinine clearance (73±41 vs 82±38 μmol/L; P=0.041), more cardiogenic shock (14.8% vs 6.6%; P=0.017) and less radial PCI (81.3% vs 90.1%; P=0.024) in women. Rates of 1-year death (22.7% vs 18.1%), TVR (8.3% vs 6.0%) and MACCE (24.3% vs 20.9%) were not statistically different in women (P>0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55-1.87; P=0.97).
Conclusion:
In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care