Sex-related differences in patients with ST-elevation myocardial infarction undergoing primary PCI: A long-term mortality study. in Cardiovascular revascularization medicine : including molecular interventions / Cardiovasc Revasc Med. 2015 Apr-May;16(3):135-40. doi: 10.1016/j.carrev.2015.02.001. Epub 2015 Feb 1
2015
AOU Città della Salute di Torino
Tipo pubblicazione
Journal Article
Autori/Collaboratori (10)Vedi tutti...
Biava LM
Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy. Electronic address: biava.lorenza@gmail.com.
Scacciatella P
Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
Calcagnile C
Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
et alii...
Abstract
OBJECTIVES: To assess sex differences in clinical presentation, in-hospital and long-term outcome in ST-elevated myocardial infarction (STEMI) patients undergoing primary PCI (PPCI). BACKGROUND: Several studies have shown higher rates of mortality in women. These differences are not always confirmed after adjusting for confounding variables. METHODS: From January 2007 to December 2011, 325 consecutive patients (23.1% females and 76.9% males) were prospectively treated and retrospectively analyzed. Primary outcome was in-hospital and long-term mortality. RESULTS: Women were older (71.8±11.7 vs. 62.5±12.6years; p<0.0001), presented more renal failure (45.3% vs. 20.8%; p<0.0001) and severe haemodynamic impairment (9.3% vs. 3.6%; p=0.04). In-hospital overall mortality (14.7% vs. 4.8%; p=0.003) and cardiac death (12% vs. 2%; p=0.002) were significantly higher in women. The multivariate analysis identified age (OR 1.07; 95% CI: 1.01-1.13), resuscitated cardiac arrest (CCA) and cardiogenic shock (CS) (OR 15.31; 95% CI: 4.30-61.75), renal failure (OR 0.20; 95% CI: 0.06-0.68), but not sex (OR 1.49; 95% CI: 0.53-4.22) as independent prognostic factors of in-hospital mortality. During a median follow-up of 46.5months (IQR range 32.7-63.1months), long-term overall mortality (24.2% vs. 11.0%; p=0.007) and cardiac death (4.8% vs. 1.7%; p=0.02) were significantly higher in women. The multivariate analysis identified age (HR 1.06; 95% CI: 1.02-1.11), previous AMI (HR 3.9; 95% CI: 1.63-9.35), renal failure (HR 5.21; 95% CI: 2.12-12.85), technical success (HR 0.35; 95% CI: 0.14-0.84) but not sex (HR 0.90; 95% CI: 0.42-1.94) as independent prognostic factors of long-term mortality. CONCLUSIONS: Worse clinical presentation rather than sex may explain the excess of mortality in women with STEMI undergoing PPCI.
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PMID : 25704157
DOI : 10.1016/j.carrev.2015.02.001
Keywords
Adult; Aged; Aged, 80 and over; Female; Hospital Mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors/blood; Male; Middle Aged; Myocardial Infarction/blood/mortality/therapy; Percutaneous Coronary Intervention/methods/mortality; Risk Factors; Sex Characteristics; Shock, Cardiogenic/therapy; Time Factors; Treatment Outcome; Acute myocardial infarction; Angioplasty; Gender;