Physicians' Academy for Cardiovascular Education

Gender differences in STEMI prognosis are age dependent

Literature - 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
 

Background

Conflicting 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.
 

Main results

  • 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)
 

Conclusion

Younger 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.
 

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