Gender and Age Differences in Short- and Long-Term Outcomes Following Primary Percutaneous Coronary Intervention for
Su-Kiat Chua1, Kou-Gi Shyu2, Huei-Fong Hung3
1Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University; ; Department of General Medicine; ; Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei;
Insights
Younger women with ST elevation myocardial infarction (STEMI) face worse outcomes than younger men. These sex-related differences in STEMI prognosis are age-dependent, impacting long-term survival.
Area of Science:
- Cardiology
- Clinical Medicine
- Gender Studies in Medicine
Background:
- ST elevation myocardial infarction (STEMI) is associated with poorer outcomes in women compared to men.
- The influence of age on these sex-based outcome disparities in STEMI remains unclear.
- Key terms: Coronary heart disease, Gender, Myocardial infarction.
Purpose of the Study:
- To investigate whether age differences explain the observed disparities in short- and long-term outcomes between men and women with STEMI.
- To compare clinical characteristics, coronary anatomy, and outcomes based on age and sex in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective analysis of 1035 consecutive STEMI patients treated with primary PCI.
- Comparison of baseline characteristics, coronary anatomy, and outcomes between young (<65 years) and older (≥65 years) patients, stratified by sex.
- Kaplan-Meier and multivariate analyses were used to assess event-free survival and predictors of long-term outcome.
Main Results:
- Younger women had less typical angina, single-vessel disease, and infarct-related artery occlusion than younger men.
- Younger women experienced higher rates of reinfarction, heart failure, and mortality compared to younger men.
- Age predicted long-term outcomes in men but not in women; no significant sex differences in outcomes were observed in older patients.
Conclusions:
- Sex-related differences in long-term STEMI outcomes are age-dependent.
- Younger women with STEMI treated with primary PCI have a worse long-term prognosis than younger men.
- Age is a significant factor influencing STEMI outcomes, with younger women being a particularly vulnerable group.
Background:
Studies have reported that women with ST elevation myocardial infarction (STEMI) have worse short- and long-term outcomes than men. It has not yet been confirmed whether these differences reflect differences in age between men and women.
Methods:
We retrospectively enrolled 1035 consecutive STEMI patients treated with primary percutaneous coronary intervention (PCI). Baseline clinical characteristics, coronary anatomy, and outcome were compared between young (< 65 years old) and older patients (≥ 65 years old) of both sexes.
Results:
Younger women presented with a lower incidence of typical angina (83% vs. 93%, p = 0.03), single-vessel disease (21% vs. 35%, p = 0.03), and total occlusion of infarct-related artery (65% vs. 83%, p = 0.001) than younger men, with no gender difference noted in the older group. Younger women in the study had a higher incidence of reinfarction, heart failure requiring admission, or mortality (23% vs. 6%, p < 0.001) during follow-up, compared with younger men, with no gender difference in the older group. Using the Kaplan-Meier analysis, younger women had lower rates of event-free survival (p < 0.001 by log-rank test) than younger men, with no gender difference in the older group. In multivariate analysis, age could predict long-term outcome in men (Hazard ratio 4.43, 95% confidence interval: 2.89-6.78, p < 0.001) but not in women.
Conclusions:
In STEMI patients receiving primary PCI, sex-related long-term outcome differences were age-dependent, with younger women likely to have a worse long-term outcome when compared with younger men.
Key Words:
Coronary heart disease; Gender; Myocardial infarction.
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