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RESEARCH PRODUCT

Long-term outcomes in men and women with ST-segment elevation myocardial infarction and incomplete reperfusion after a primary percutaneous coronary intervention

Marianna JanionMariusz GąsiorKrzysztof WilczekMarek GierlotkaMarcin SadowskiMałgorzata Zachura

subject

Malesex differencesTime Factorsmedicine.medical_treatmentCoronary Artery Disease030204 cardiovascular system & hematology0302 clinical medicineRisk FactorsPrevalenceRegistriesTreatment Failure030212 general & internal medicineMyocardial infarctionStrokeAged 80 and overIncidenceMortality rateHazard ratioGeneral MedicineMiddle Agedprimary percutaneous coronary interventionCardiologyFemaleCardiology and Cardiovascular Medicinelong-term outcomesTIMImedicine.medical_specialtyPatient ReadmissionRisk Assessment03 medical and health sciencesPercutaneous Coronary InterventionSex FactorsReperfusion therapyCoronary CirculationInternal medicinemedicineHumanscardiovascular diseasesAgedHeart Failurebusiness.industryPercutaneous coronary interventionHealth Status Disparitiesmedicine.diseaseST-segment elevation myocardial infarctionincomplete reperfusionHeart failureST Elevation Myocardial InfarctionPolandbusiness

description

Background The failure of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) is more frequent than considered previously. Aim To evaluate sex-related differences in long-term outcomes in patients with STEMI and incomplete infarct-related artery reperfusion after a primary percutaneous coronary intervention. Patients and methods Of consecutive 42 752 patients with STEMI hospitalized between 2009 and 2011 in Poland, we analyzed a group of 766 (35%) women and 1453 (65%) men with less than thrombolysis in myocardial infarction (TIMI) flow grade 3 following a primary percutaneous coronary intervention. Results In the 2-year follow-up, the mortality rate among women was significantly higher compared with men: 39.8 versus 30.9% (P = 0.0009) in the TIMI 0 or 1 group, and 31.6 versus 20% (P < 0.0001) in the TIMI 2 group. In women, the risk of rehospitalization because of heart failure was significantly higher irrespective of the final TIMI flow grade. In the multivariate analysis, female sex did not influence both in-hospital (odds ratio: 1.09; 95% confidence interval: 0.82–1.44; P = 0.54) and long-term (hazard ratio: 1.14; 95% confidence interval: 0.97–1.34; P = 0.11) mortality. Peripheral artery disease, anterior myocardial infarction, and previous stroke were associated with increased mortality only in men. Postprocedural TIMI flow grade 2 (vs. TIMI grade 0 or 1) was the strongest factor impacting mortality irrespective of sex. Conclusion Women with STEMI and postprocedural suboptimal epicardial blood flow have higher mortality than men and are at high risk of developing heart failure, with frequent in-patient visits. However, these differences may be attributed to the advanced age and worse clinical presentation of women compared with men

yearjournalcountryeditionlanguage
2019-05-01Coronary Artery Disease
https://doi.org/10.1097/mca.0000000000000703