Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI

Abstract

AimsTo investigate gender difference in mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (PPCI).MethodsWe analyzed data from the prospective registries of two hub PPCI centres over a 10-year period to assess the role of female gender as an independent predictor of both all-cause and cardiac death at 30 days and 1 year. To account for all confounding variables, a propensity score (PS)-adjusted multivariable Cox regression model and a PS-matched comparison between the male and female were used.ResultsAmong 4370 consecutive STEMI patients treated with PPCI at participating centres, 1188 (27.2%) were women. The survival rate at 30 days and 1 year were significantly lower in women (Log-rank P-value < 0.001). At PS-adjusted multivariable Cox regression analysis, female gender was independently associated with an increased risk of 30-day all-cause death [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.45–3.01, P < 0.001], 30-day cardiac death (HR = 2.03;95% CI:1.41–2.93, P < 0.001), 1-year all-cause death (HR = 1.45; 95% CI:1.16–1.82, P < 0.001) and 1-year cardiac death (HR = 1.51; 95% CI:1.15–1.97, P < 0.001). For the study outcome, we found a significant interaction of gender with the multivessel disease in females who were at increased risk of mortality in comparison with men in absence of multivessel disease. After the PS matching procedure, a subset of 2074 patients were identified. Women still had a lower survival rate and survival free from cardiac death rate both at 30-day and at 1-year follow-up.ConclusionAs compared with men, women with STEMI treated with PPCI have higher risk of both all-cause death and cardiac mortality at 30-day and 1-year follow-up.

Systemic Immune-Inflammation Index and Systemic Inflammatory Response Index as Predictors of Mortality in ST-Elevation Myocardial Infarction

“…In the whole population, mean (DS) levels of SIRI and SII correspond to 3.9 (3.4) and 1090 (905), respectively; moreover, a significant positive correlation was observed between SIRI and SII (r = 0.8, p < 0.001). As expected, female patients accounted for approximately a third of the overall population in agreement with previous results, as men are more likely to incur coronary heart disease [26].…”

Sex, Racial, and Ethnic Disparities in Acute Coronary Syndrome: Novel Risk Factors and Recommendations for Earlier Diagnosis to Improve Outcomes

“…Of 2074 subjects undergoing primary PCI for STEMI between 2006 and 2016 in Italy, the propensity score–adjusted HR for women was 2.09 (95% CI, 1.45–3.01; P <0.001) for 30-day all-cause mortality compared with men (Table 2). 34 In a retrospective analysis of PCI for ACS of 4776 patients in Australia between 2008 and 2015, PCI success was similar in women and men (97.7% versus 97.8%, respectively). Women had a higher unadjusted 1-year mortality of 6.4% versus 4%; P =0.0012, but after adjustment for the older age of women and their higher rates of hypertension, diabetes, and obesity, there was no difference in mortality (Table 2).…”

Unveiling the gender gap in ST-elevation myocardial infarction: a retrospective analysis of a single Italian center gender disparities in STEMI-ACS

“…In contrast with our results, previous literature demonstrated worse short-term outcomes in women with STEMI compared with men. 16,17 Of note, some studies suggest that gender disparities in in-hospital and 30 days' mortality is attenuated if restricting the analysis to STEMI patients undergoing primary PCI, and might be overcome in highquality PCI centers. [18][19][20] Moreover, the gender gap in short-term mortality was mostly observed in young patients (i.e.…”