Does female sex impact management and early outcomes in STEMI patients treated with primary PCI?
Women with STEMI treated with primary PCI have a higher risk profile, different metabolic/inflammatory responses, and higher in-ICCU mortality compared to men, suggesting a need for more intensive care.
OBJECTIVE: Still contrasting are data on the impact of sex on outcome in patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). DESIGN: We sought sex-related differences in management and early outcomes in 1127 STEMI patients submitted to PCI consecutively admitted to our intensive cardiac care unit (ICCU) in Florence from 1 January 2004 to 31 December 2009. RESULTS: Females were significantly older, leaner (p < 0.001, respectively), more hypertensive (p < 0.001), and diabetic (p = 0.016); they showed a higher incidence of neurological impairment (p = 0.002) and chronic obstructive pulmonary disease (p = 0.048). Higher Killip classes were more frequent in females (p = 0.015). Door-to-balloon time was higher in females (p < 0.001) who showed a higher incidence of major bleeding (p < 0.001) and a higher in-ICCU mortality rate (p = 0.037). The use of IIbIIIa glycoprotein inhibitors was lower in females (p < 0.001) who exhibited higher values of admission glycaemia and peak glycaemia (p < 0.001 and p < 0.001, respectively), higher values of fibrinogen (p < 0.001) and erythrocyte sedimentation rate (p < 0.001), and lower eGFR and haemoglobin values (p < 0.001). CONCLUSIONS: According to our data, STEMI women show not only a different risk profile (older age, comorbidities, lower haemoglobin values), but also a different gender-related metabolic and inflammatory responses to acute myocardial ischaemia in respect to men. All these factors can account for the higher in-ICCU mortality in women and strongly suggest that STEMI women deserve more intensive care due to a more severe haemodynamic derangement (as indicated by the higher use of inotropes, diuretics, and non-invasive ventilation) and to a more serious metabolic impairment (as inferred by higher glucose values).
Valente et al. (2011) studied this question.