Gender differences in STEMI prognosis are age dependentLiterature - Otten AM, Maas AHEM, Ottervanger JP, et al. - EHJ Acute Cardiovasc Care 2013 DOI: 10.1177/2048872612475270
Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent?: Gender difference in STEMI stratified on age
Otten AM, Maas AHM, Ottervanger JP, et al.
EHJ Acute Cardiovasc Care 2013 DOI: 10.1177/2048872612475270
BackgroundConflicting results have been reported regarding gender differences in prognosis after primary percutaneous coronary intervention (PPCI) in ST-segment elevation acute myocardial infarction (STEMI) [1-6]. Poorer outcomes in women with STEMI were often attributed to gender differences in baseline characteristics [7-10]. As most studies did not stratify into age groups, it is less clear whether these gender differences in prognosis after STEMI are age dependent. This study from the Zwolle Myocardial Infarction Study Registry examined the importance of gender in separate age groups of patients with STEMI undergoing primary PPCI. Data of 6746 consecutive patients with STEMI admitted for PPCI between 1998 and 2008 were evaluated (4991 (74.0%) men and 1755 (26.0%) women). Age was stratified into two groups, <65 years (young group) and ≥65 years (elderly). Endpoints were enzymic infarct size as well as 30-day and 1 year mortality.
- 40% of the women were <65 years old and 60% of the men were <65 years old.
- Hypertension was more prevalent in women within both age groups than in men. In younger women, a positive family history and current smoking were significantly more present, while at older age women had more hypertension and diabetes.
- At angiography, single-vessel disease and TIMI 3 flow before PPCI was more present in younger women than men; these differences were not found in the older age group.
- Patient delay before admission was shorter in men at all ages; women had lower creatine kinase levels.
- Women compared to men in the younger age group had a significantly increased risk of mortality both 30 days (HR 2.1, 95% CI 1.3−3.4) and at 1 year (HR 1.7, 95% CI 1.2−2.6).
- Mortality at 30 days was also higher in women in the older age group (HR 1.5, 95% CI 1.1−2.0), but not mortality at 1 year (HR 1.2, 95% CI 0.9−1.5).
- After multivariate analysis, 1-year mortality remained significantly higher in women at younger age (HR 1.7, 95% CI 1.1−2.5)
ConclusionYounger women with STEMI treated with PPCI have a higher mortality than similarly aged men, despite the presence of less obstructive coronary artery disease and better TIMI 3 flow before PCI. More data are needed to explain these differences to improve prognosis in younger women.
1. Vakili BA, Kaplan RC and Brown DL. Sex-based differences in early mortality of patients undergoing primary angioplasty for first myocardial infarction. Circulation 2001; 104:
2. Peterson ED, Lansky AJ, Kramer J, et al.; National Cardiovascular Network Clinical Investigators. Effect of gender on the outcomes of contemporary percutaneous coronary intervention. Am J Cardiol 2001; 88: 359–364.
3. Duvernoy CS, Smith DE, Manohar P, et al. Gender differences in adverse outcomes after contemporary percutaneous coronary intervention: an analysis from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) percutaneous coronary intervention registry. Am Heart J 2010; 159: 677–683.
4. Singh M, Rihal CS, Gersh BJ, et al. Mortality between men and women after percutaneous coronary interventions: 25-year, single-center experience. J Am Coll Cardiol 2008; 51: 2313–2320.
5. Akhter N, Milford-Beland S, Roe MT, et al. Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). Am Heart J 2009; 157: 141–148.
6. Radovanovic D, Erne P, Urban P, et al.; AMIS Plus Investigators. Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20290 patients from the AMIS plus registry. Heart 2007; 93: 1369–1375.
7. Arbustini E, Dal Bello B, Morbini P, et al. Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction. Heart 1999; 82: 269–272.
8. Farb A, Burke AP, Tang AL, et al. Coronary plaque erosion without rupture into a lipid core: a frequent cause of coronary thrombosis in sudden coronary death. Circulation 1996; 93: 1354–1363.
9. Frink RJ. Gender gap, inflammation and acute coronary disease: are women resistant to atheroma growth? Observations at autopsy. J Invasive Cardiol 2009; 21: 270–277.
10. Shaw LJ, Bugiardini R and Bairey Merz CN. Women and ischemic heart disease. J Am Coll Cardiol 2009; 54: 1561–1575.