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Published on: May 28, 2019
Gender-Specific Differences in All-Cause Mortality Between Incomplete and Complete Revascularization in Patients With
Aukelien C Dimitriu-Leen1, Maaike P J Hermans1, Alexander R van Rosendael2
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
For ST-elevation myocardial infarction (STEMI) patients, incomplete revascularization increases long-term mortality in men but not women. Gender does not impact 30-day mortality risk from revascularization strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Revascularization strategies for ST-elevation myocardial infarction (STEMI) remain debated.
- The impact of gender on revascularization outcomes in STEMI patients is not fully understood.
Purpose of the Study:
- To investigate gender-specific differences in all-cause mortality between incomplete and complete revascularization in STEMI patients with multi-vessel coronary artery disease.
- To analyze short-term (30-day) and long-term (5-year) mortality outcomes.
Main Methods:
- Retrospective analysis of 375 men and 115 women with first STEMI and multi-vessel coronary artery disease.
- Patients were categorized by gender and revascularization strategy (incomplete vs. complete).
- 30-day and 5-year all-cause mortality were assessed, with adjustments for baseline and angiographic factors.
Main Results:
- No significant gender-strategy interaction for 30-day mortality after STEMI.
- Incomplete revascularization was associated with higher 30-day mortality in both men and women compared to complete revascularization.
- Among 30-day survivors, incomplete revascularization independently predicted 5-year all-cause mortality in men (HR 3.07) but not in women (HR 0.60).
Conclusions:
- Short-term mortality (30-day) following STEMI is not influenced by gender-specific revascularization strategies.
- Incomplete revascularization poses a significant long-term mortality risk for male STEMI survivors.
- Women with STEMI may have different long-term prognoses regarding revascularization strategy compared to men.
Abstract:
The best revascularization strategy (complete vs incomplete revascularization) in patients with ST-elevation myocardial infarction (STEMI) is still debated. The interaction between gender and revascularization strategy in patients with STEMI on all-cause mortality is uncertain. The aim of the present study was to evaluate gender-specific difference in all-cause mortality between incomplete and complete revascularization in patients with STEMI and multi-vessel coronary artery disease. The study population consisted of 375 men and 115 women with a first STEMI and multi-vessel coronary artery disease without cardiogenic shock at admission or left main stenosis. The 30-day and 5-year all-cause mortality was examined in patients categorized according to gender and revascularization strategy (incomplete and complete revascularization). Within the first 30 days, men and women with incomplete revascularization were associated with higher mortality rates compared with men with complete revascularization. However, the gender-strategy interaction variable was not independently associated with 30-day mortality after STEMI when corrected for baseline characteristics and angiographic features. Within the survivors of the first 30 days, men with incomplete revascularization (compared with men with complete revascularization) were independently associated with all-cause mortality during 5 years of follow-up (hazard ratios 3.07, 95% confidence interval 1.24;7.61, p = 0.016). In contrast, women with incomplete revascularization were not independently associated with 5-year all-cause mortality (hazard ratios 0.60, 95% confidence interval 0.14;2.51, p = 0.48). In conclusion, no gender-strategy differences occurred in all-cause mortality within 30 days after STEMI. However, in the survivors of the first 30 days, incomplete revascularization in men was independently associated with all-cause mortality during 5-year follow-up, but this was not the case in women.
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