Rita Calé1, Lídia de Sousa2, Hélder Pereira3, Marco Costa4, Manuel de Sousa Almeida5. 1. Unidade de Cardiologia de Intervenção, Hospital Garcia de Orta, Almada, Portugal. Electronic address: ritacale@hotmail.com. 2. Unidade de Cardiologia de Intervenção, Centro hospitalar de Lisboa Central, Lisboa, Portugal. 3. Unidade de Cardiologia de Intervenção, Hospital Garcia de Orta, Almada, Portugal. 4. Unidade de Cardiologia de Intervenção, Centro hospitalar de Coimbra, Coimbra, Portugal. 5. Unidade de Cardiologia de Intervenção, Hospital de Santa Cruz, C.H.L.O., Carnaxide, Portugal.
Abstract
AIMS: Although mortality after primary percutaneous coronary intervention (PPCI) is higher in women than in men, there is disagreement as to whether gender is an independent risk factor for mortality in ST- elevation myocardial infarction (STEMI). Our aim was to assess how gender influenced short-term prognosis in patients undergoing PPCI in the Portuguese Registry of Interventional Cardiology. METHODS: Of 60 158 patients prospectively included in a large registry of contemporary PCI, from 2002 to 2012, we included 7544 patients with STEMI treated by PPCI, of whom 1856 (25%) were female. The effect of gender on in-hospital mortality was assessed by multivariate logistic regression analysis with propensity score matching. RESULTS: Women were older (68±14 vs. 61±13 years, p<0.001), with a higher prevalence of diabetes (30% vs. 21%, p<0.001) and hypertension (69% vs. 55%, p<0.001). Men were more frequently revascularized within six hours of symptom onset (71% vs. 63%, p<0.001). Cardiogenic shock was more frequent in women (7.1% vs. 5.7%, p=0.032). Female gender was associated with a worse short-term prognosis, with 1.7 times higher risk of in-hospital death (4.3% in women and 2.5% in men, 95% confidence interval (CI) 1.30-2.27, p<0.001). After computed propensity score matching based on baseline clinical characteristics, in-hospital mortality was similar between women and men (odds ratio 1.00, 95% CI 0.68-1.48, p=1.00). CONCLUSIONS: In the Registry, women with STEMI treated by PPCI had a greater risk-factor burden, less timely access to treatment and a worse prognosis. However, after risk adjustment, female gender ceases to be an independent predictor of in-hospital mortality.
AIMS: Although mortality after primary percutaneous coronary intervention (PPCI) is higher in women than in men, there is disagreement as to whether gender is an independent risk factor for mortality in ST- elevation myocardial infarction (STEMI). Our aim was to assess how gender influenced short-term prognosis in patients undergoing PPCI in the Portuguese Registry of Interventional Cardiology. METHODS: Of 60 158 patients prospectively included in a large registry of contemporary PCI, from 2002 to 2012, we included 7544 patients with STEMI treated by PPCI, of whom 1856 (25%) were female. The effect of gender on in-hospital mortality was assessed by multivariate logistic regression analysis with propensity score matching. RESULTS:Women were older (68±14 vs. 61±13 years, p<0.001), with a higher prevalence of diabetes (30% vs. 21%, p<0.001) and hypertension (69% vs. 55%, p<0.001). Men were more frequently revascularized within six hours of symptom onset (71% vs. 63%, p<0.001). Cardiogenic shock was more frequent in women (7.1% vs. 5.7%, p=0.032). Female gender was associated with a worse short-term prognosis, with 1.7 times higher risk of in-hospital death (4.3% in women and 2.5% in men, 95% confidence interval (CI) 1.30-2.27, p<0.001). After computed propensity score matching based on baseline clinical characteristics, in-hospital mortality was similar between women and men (odds ratio 1.00, 95% CI 0.68-1.48, p=1.00). CONCLUSIONS: In the Registry, women with STEMI treated by PPCI had a greater risk-factor burden, less timely access to treatment and a worse prognosis. However, after risk adjustment, female gender ceases to be an independent predictor of in-hospital mortality.
Keywords:
Angioplastia primária; Enfarte agudo do miocárdio com supradesnivelamento de ST; Female; Primary angioplasty; ST‐elevation myocardial infarction; Sexo feminino
Authors: Hélder Pereira; Daniel Caldeira; Rui Campante Teles; Marco Costa; Pedro Canas da Silva; Vasco da Gama Ribeiro; Vítor Brandão; Dinis Martins; Fernando Matias; Francisco Pereira-Machado; José Baptista; Pedro Farto E Abreu; Ricardo Santos; António Drummond; Henrique Cyrne de Carvalho; João Calisto; João Carlos Silva; João Luís Pipa; Jorge Marques; Paulino Sousa; Renato Fernandes; Rui Cruz Ferreira; Sousa Ramos; Eduardo Infante Oliveira; Manuel de Sousa Almeida Journal: BMC Cardiovasc Disord Date: 2018-04-24 Impact factor: 2.298