Women with STEMI undergoing primary PCI had a higher 1-year rate of death or heart failure hospitalization compared to men, which was not explained by differences in infarct size or LVEF.
Meta-Analysis (n=2,632)
Yes
Does female sex compared to male sex affect the 1-year rate of death or heart failure hospitalization in patients with STEMI undergoing primary PCI?
Women have a higher 1-year risk of death or heart failure hospitalization after primary PCI for STEMI compared to men, a disparity that is not explained by differences in infarct size or left ventricular ejection fraction.
AIM: Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. METHODS AND RESULTS: We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1 month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P < 0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. CONCLUSIONS: In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.
Kosmidou et al. (Mon,) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=2,632). Female sex vs. Male sex was evaluated on Composite rate of death or heart failure (HF) hospitalization within 1 year. Women with STEMI undergoing primary PCI had a higher 1-year rate of death or heart failure hospitalization compared to men, which was not explained by differences in infarct size or LVEF.