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Gender-related differences in long-term outcome among high-risk patients with myocardial infarction treated
Julita Sarek1, Anita Paczkowska1, Bartosz Wilczyński1
1Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.
Insights
Female patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) face higher long-term mortality, particularly those with incomplete coronary revascularization (ICR) or low ejection fraction (EF). This gender disparity highlights the need for tailored risk assessment in high-risk populations.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) improves outcomes for acute myocardial infarction (AMI).
- High-risk patient populations with comorbidities present unique challenges in AMI management.
- Understanding gender-specific differences in long-term prognosis is crucial for optimizing care.
Purpose of the Study:
- To investigate gender-related disparities in long-term mortality among high-risk patients following AMI treated with PCI.
- To identify specific high-risk subgroups where gender influences prognosis.
Main Methods:
- Analysis of a single-center registry of 4375 AMI patients treated with PCI.
- Stratification into high-risk groups: age > 70, glomerular filtration rate (GFR) < 60, diabetes mellitus (DM), low ejection fraction (EF < 35%), and incomplete coronary revascularization (ICR).
- Comparative analysis of long-term mortality between genders within each high-risk group.
Main Results:
- No significant gender differences in mortality for age > 70 and GFR < 60 groups.
- A trend towards higher mortality in women was observed in the DM (p=0.06) and EF < 35% (p=0.07) groups.
- Significantly higher long-term mortality in women compared to men was found in the ICR group (19.7% vs. 27.3%, p < 0.001) and the EF < 35% group (p < 0.05).
Conclusions:
- Female gender is associated with increased long-term mortality in specific high-risk AMI patient groups, notably those with ICR and EF < 35%.
- While a trend suggests worse prognosis for diabetic women, further research is needed.
- The observed worse prognosis in women was often linked to comorbidities and clinical characteristics, indicating a complex interplay of factors.
Introduction:
Treating acute myocardial infarction (AMI) with percutaneous coronary intervention (PCI) has an impact on improving long-term outcome. However, patients with other comorbidities are challenging, and are considered as a high-risk population.
Aim:
To assess gender-related differences in long-term prognosis after AMI among high-risk patients.
Material And Methods:
The single-center registry encompassed 4375 AMI patients treated with PCI. The following high-risk groups were selected: age > 70 group (n = 1081), glomerular filtration rate (GFR ) < 60 group (n = 848), diabetes mellitus (DM) group (n = 782), low ejection fraction (EF) group (n = 560) defined as EF < 35%, and incomplete coronary revascularization (ICR) group (n = 2008). Within each group, comparative analysis of long-term mortality with respect to gender and age was performed.
Results:
There were no significant differences in long-term mortality with respect to gender among groups with age > 70 (29.0% vs. 30.3%) and GFR < 60 (37.2% vs. 42.3%) (both p = NS respectively for men vs. women). In the DM group (24.8% vs. 30.8%; p = 0.06) and EF < 35% group (36.3% vs. 44.5%; p = 0.07) there was a trend towards significance. The ICR group showed a higher mortality rate with respect to gender (19.7% vs. 27.3%; p < 0.001). Differences in survival assessed by the log-rank test were significant among ICR and EF < 35% groups.
Conclusions:
Female gender is related to higher long-term mortality among high-risk groups, but a statistically significant difference was observed only in patients with ICR and those with EF < 35%. Female gender may be associated with worse prognosis in diabetic patients, but it needs evaluation. However, worse prognosis in women was not independent and was associated mainly with other comorbidities and worse clinical characteristics.
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