Comparison of baseline characteristics, clinical features, angiographic results, and early outcomes in men vs women with acute myocardial infarction undergoing primary coronary intervention
- PMID: 15249441
- DOI: 10.1378/chest.126.1.47
Comparison of baseline characteristics, clinical features, angiographic results, and early outcomes in men vs women with acute myocardial infarction undergoing primary coronary intervention
Abstract
Background: Women have had a higher early mortality rate than men after acute myocardial infarction (AMI) in the prethrombolytic and thrombolytic eras. Primary percutaneous coronary intervention (PCI) has been shown to significantly improve survival of patients with AMI, and to be superior to thrombolytic therapy in terms of immediate restoration of normal flow in the infarct-related artery and reduction of recurrent ischemic events. However, the effect of primary PCI on early outcomes of women vs men remains unknown. Therefore, we examined whether there was any difference in term of 30-day mortality between women and men after primary PCI.
Methods and results: Between May 1993 and April 2002, primary PCI was performed in 1,032 consecutive patients (15.3% women and 84.7% men) with AMI. The overall successful reperfusion (final Thrombolysis in Myocardial Infarction grade 3 flow) and 30-day morality rates were 84.0% and 8.5%, respectively. The rate of successful reperfusion did not differ between women and men (84.8% vs 83.9%, p = 0.77). However, mortality at 30 days was significantly higher in women than in men (14.6% vs 7.4%, p = 0.003). In comparison with men, women were older; had significantly higher incidences of hypertension, diabetes mellitus, complete atrioventricular block, and right ventricular infarction; and had longer times of reperfusion (all p values < 0.05). During hospitalization, advanced congestive heart failure (New York Heart Association class 3 or greater), free wall rupture, and major bleeding complications were more likely to occur in women than in men (all p values < 0.05). Compared with men, the unadjusted odds ratio for 30-day death among women was 2.12 (95% confidence interval [CI], 1.27 to 3.53). After adjusting for age, the odds ratio was substantially reduced to 1.66 (95% CI, 0.98 to 2.79). Further adjustment for age and other variables further reduced the odds ratio to 1.06 (95% CI, 0.53 to 2.14).
Conclusions: A gender gap of 30-day mortality existed between women and men with AMI that could not be altered by primary PCI. However, this gap was only an apparent one, and was not truly related to gender alone. In comparison with men, women were older, had significantly higher incidences of comorbidities and major untoward clinical events, and had longer times of reperfusion, which could help explain why the 30-day mortality rate was higher in women than in men.
Similar articles
-
Impact of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction patients in Thailand.J Med Assoc Thai. 2007 Oct;90 Suppl 1:65-73. J Med Assoc Thai. 2007. PMID: 18431888
-
Delayed post-myocardial infarction invasive measures, helpful or harmful? A subgroup analysis.Chest. 2004 Jul;126(1):38-46. doi: 10.1378/chest.126.1.38. Chest. 2004. PMID: 15249440
-
Prognostic value of circulating levels of endothelin-1 in patients after acute myocardial infarction undergoing primary coronary angioplasty.Chest. 2005 May;127(5):1491-7. doi: 10.1378/chest.127.5.1491. Chest. 2005. PMID: 15888819
-
Gender differences in the outcome of cardiac interventions.Herz. 2005 Aug;30(5):375-89. doi: 10.1007/s00059-005-2716-3. Herz. 2005. PMID: 16132240 Review. English, German.
-
Safety and efficacy of intracoronary adenosine administration in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials.Ther Adv Cardiovasc Dis. 2012 Jun;6(3):101-14. doi: 10.1177/1753944712446670. Epub 2012 May 4. Ther Adv Cardiovasc Dis. 2012. PMID: 22562999 Review.
Cited by
-
Factors associated with health-related quality of life in patients undergoing percutaneous coronary intervention: Thai PCI registry.Front Cardiovasc Med. 2023 Nov 8;10:1260993. doi: 10.3389/fcvm.2023.1260993. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 38028486 Free PMC article.
-
Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction.Front Cardiovasc Med. 2022 Jul 4;9:863811. doi: 10.3389/fcvm.2022.863811. eCollection 2022. Front Cardiovasc Med. 2022. PMID: 35859592 Free PMC article.
-
Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis.Curr Cardiol Rev. 2023;19(1):e300622206530. doi: 10.2174/1573403X18666220630120259. Curr Cardiol Rev. 2023. PMID: 35786190 Free PMC article.
-
Impact of regionalizing ST-elevation myocardial infarction care on sex differences in reperfusion times and clinical outcomes.Clin Cardiol. 2021 Aug;44(8):1113-1119. doi: 10.1002/clc.23658. Epub 2021 Jun 8. Clin Cardiol. 2021. PMID: 34101211 Free PMC article.
-
Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry.Eur Heart J. 2020 Nov 7;41(42):4127-4137. doi: 10.1093/eurheartj/ehaa662. Eur Heart J. 2020. PMID: 33049774 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous