Gender‐Related Mortality and In‐Hospital Complications Following ST‐Segment Elevation Myocardial Infarction: Data From a Primary Percutaneous Coronary Intervention Cohort

Abstract

Background:The increased mortality related to female gender in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) has been reported from various patient cohorts and treatment strategies with controversial results. In the present work, we evaluated the impact of female gender on mortality and in-hospital complications among a specific subset of consecutive STEMI patients managed solely by PPCI. Hypothesis: Female gender is not an independent predicor for mortality among STEMI patients. Methods: We performed a retrospective, single-center observational study that included 1346 consecutive STEMI patients undergoing PPCI, of which 1075 (80%) were male. Patient's records were evaluated for 30-day mortality, in-hospital complications, and long-term mortality over a mean period of 2.7 ± 1.6 years. Results: Compared with males, females were older (69 ± 13 vs 60 ± 13 years, P < 0.001), had a significantly higher rate of baseline risk factors, and had prolonged symptom duration (460 ± 815 minutes vs 367 ± 596 minutes, P = 0.03). Females suffered from more in-hospital complications and had higher 30-day mortality (5% vs 2%, P = 0.008) as well as higher overall mortality (12.5% vs 6%, P < 0.001). In spite of the significant mortality risk in unadjusted models, a multivariate adjusted Cox regression model did not demonstrate that female gender was an independent predictor for mortality among STEMI patients. Conclusions: Among patients with STEMI treated by PPCI, female gender is associated with a higher 30-day mortality and complications rates compared to males. Following multivariate analysis, female gender was not a significant predictor of long-term death following STEMI.

Gender differences in risk factors and clinical outcomes in young patients with acute myocardial infarction

“…However, young women with AMI had an increased risk of in-hospital mortality and 1-year MACEs. Importantly, our study showed no significant gender difference in door-to-balloon time; however, young women with AMI showed a slight delay compared with men in the time between the onset of symptoms and arrival in the emergency room, which was similar to previous data for older age groups 30. These differences may be secondary to the atypical symptoms experienced by females or subject to underdiagnosis by medical staff unfamiliar with the uncharacteristic presentation of AMI among females;31 nevertheless, this is particularly disadvantageous in young women at risk of AMI.…”

Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention

“…1 ). This gender differences also reflect in 30-day mortality [OR 0.64, 95% CI 0.61–0.66, P = .04, I 2 = 40%; 19 studies (n = 523,304)], [ 2 – 4 , 7 , 8 , 13 – 17 , 23 , 25 , 26 , 33 – 36 , 42 , 53 ] 1-year mortality [OR 0.67, 95% CI 0.60–0.75, P < .001, I 2 = 73%; 20 studies (n = 590,590)] [ 8 , 10 , 13 , 15 – 17 , 20 , 25 , 26 , 28 , 30 , 33 , 35 , 36 , 38 , 43 , 44 , 53 – 55 ] and >2-years mortality [OR 0.71, 95% CI 0.63–0.79, P = .005, I 2 = 57%; 14 studies (n = 43,096)] [ 4 – 6 , 18 , 19 , 23 , 29 , 31 , 34 , 36 , 40 , 43 , 52 , 56 ] (Figs. 2 – 4 ).…”

Quality of life at six months after primary percutaneous coronary intervention performed at a predominantly rural population

“…Studies have reported even increased mortality in females as compared to males undergoing PPCI for STEMI. 18,19 This finding is due in part to the fact that men report better QoL at baseline compared with women, and baseline QoL is a strong predictor of postrevascularization QoL. Another contributing factor is that women have more recurrent angina after PCI than men therefore persistent angina symptoms might cause lower HRQOL.…”