Gender Related Survival Differences in ST-Elevation Myocardial Infarction Patients Treated with Primary PCI
Vojko Kanic1, Maja Vollrath2, Franjo Husam Naji1
11. University Medical Centre Maribor, Maribor, Slovenia;
Insights
Gender does not independently predict mortality in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Older age and severe clinical conditions, not sex, are the primary drivers of higher mortality rates in women with STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Conflicting data exists regarding gender as an independent risk factor for mortality in ST-elevation myocardial infarction (STEMI) patients.
- This study aimed to evaluate the influence of gender on in-hospital and long-term mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To determine if gender is an independent predictor of mortality in STEMI patients undergoing primary PCI.
- To identify factors contributing to observed mortality differences between genders in this patient population.
Main Methods:
- Analysis of 2069 STEMI patients who underwent primary PCI between January 2009 and December 2014.
- Assessment of in-hospital mortality using binary logistic regression and long-term mortality via Cox regression analysis.
- Multivariate adjustment for potential confounding factors including age, comorbidities, and clinical presentation.
Main Results:
- Women were older and presented more frequently with diabetes and cardiogenic shock, and received bivalirudin less often.
- In-hospital mortality was higher in women (14.2%) compared to men (7.8%), but sex was not an independent predictor after adjustment.
- Long-term mortality was also significantly higher in women (23.6%) versus men (15.1%), yet gender did not emerge as an independent prognostic factor in multivariate analysis.
Conclusions:
- Higher mortality rates observed in women with STEMI undergoing primary PCI are primarily attributable to older age and more severe clinical presentation, rather than gender itself.
- Factors such as advanced age and cardiogenic shock are significant independent predictors of both in-hospital and long-term mortality in this cohort.
Background:
Data about gender as an independent risk factor for death in ST-elevation myocardial infarction (STEMI) patients is still contrasting. Aim was to assess how gender influences in-hospital and long-term all-cause mortality in STEMI patients with primary percutaneous coronary intervention (PCI) in our region.
Methods:
We analysed data from 2069 STEMI patients undergoing primary PCI in our institution from January 2009-December 2014, of whom 28.9% were women. In-hospital and long-term mortality were observed in women and men. The effect of gender on in-hospital mortality was assessed by binary logistic regression modelling and by Cox regression analysis for long-term mortality.
Results:
Women were older (68.3±61.8 vs 61.8±12.0 years; p<0.0001), with a higher prevalence of diabetes (13.7% vs 9.9%; p=0.013) and tend to be more frequently admitted in cardiogenic shock (8.4% vs 6.3%; p =0.085). They were less frequently treated with bivalirudin (15.9% vs 20.3%; p=0.022). In-hospital mortality was higher among women (14.2% vs 7.8%; p<0.0001). After adjustment, age (adjusted OR: 1.05; 95% CI: 1.03 to 1.08; p < 0.001) and cardiogenic shock at admission (adjusted OR: 24.56; 95% CI: 11.98 to 50.35; p < 0.001), but not sex (adjusted OR: 1.47; 95% CI: 0.80 to 2.71) were identified as prognostic factors of in-hospital mortality. During the median follow-up of 27 months (25th, 75th percentile: 9, 48) the mortality rate (23.6% vs 15.1%; p<0.0001) was significantly higher in women. The multivariate adjusted Cox regression model identified age (HR 1.05; 95% CI 1.04-1.07; p<0.0001), cardiogenic shock at admission (HR 6.09; 95% CI 3.78-9.81; p<0.0001), hypertension (HR 1.49; 95% CI 1.02-2.18; p<0.046), but not sex (HR 1.04; 95% CI 0.74-1.47) as independent prognostic factors of follow-up mortality.
Conclusion:
Older age and worse clinical presentation rather than gender may explain the higher mortality rate in women with STEMI undergoing primary PCI.
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
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations