Female sex was not an independent predictor of 8-year all-cause mortality after STEMI when adjusted for age (HR 1.05; 95% CI 0.86-1.08; p=0.691), despite higher unadjusted mortality than men.
Cohort (n=3,079)
Does female sex increase long-term all-cause mortality in STEMI patients treated with pPCI compared to male sex?
The higher unadjusted long-term mortality observed in women following STEMI is driven by older age and other baseline differences rather than female sex itself.
Effect estimate: HR 1.05 (95% CI 0.86-1.08)
Absolute Event Rate: 11.5% vs 7.5%
p-value: p=0.691
Abstract Background/aim Outcome following ST-elevation myocardial infarction (STEMI) is usually thought to be worse in women than in men, but some authors suggested that this difference may be caused by the difference in age and/or other clinical characteristics. The aim of this study was to analyze the impact of sex and age on long-term all-cause mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Method we analyze 3079 patients included in the University Clinical Center of our country STEMI Register hospitalized between 1 December 2005 and 31 December 2016. Patients presenting with cardiogenic shock were excluded. The follow-up period was 8 years. Results Out of 3079 patients, 2238 (72.6%) patients were men and 841 (27.2%) patients were women. The mean age of all analyzed patients was 60 (IQR 62, 69) years; women were older than men: 64 (IQR 57, 73) years vs 58 (IQR 50, 67) years, respectively, p0.001. Also, compared with men, women were more likely to have previous coronary artery disease, diabetes, hypertension, hyperlipidemia, chronic kidney disease, heart failure at admission, post-procedural flow TIMI3 and lower pre-discharge left ventricular ejection fraction (EF). Kaplan-Meier analysis showed a higher mortality in women than in men: 11.5% vs 7.5%, respectively, p0.001; (Figure 1). Univariable Cox analysis also showed that female sex was a predictor for 8-year all-cause mortality (HR 1.58, 95%CI 1.21-2.08, p=0.025). After age stratification (≤65 years and 65 years) there was no difference in mortality between men and women, as shown in Figure 2. Cox regression multivariable analysis also confirmed that sex was not an independent predictor for 8-year mortality (HR 1.05, 85%CI 0.86-1.08, p=0.691). On the other hand, (older) age was an independent predictor for 8-year mortality (HR1.02; 95%CI 1.01-1.05, p0.001). Other independent predictors were post-procedural flow TIMI3 (HR 2.12; 95%CI 1.52-2.97, p0.001); lower pre-discharge EF (HR 0.92; 95%CI 0,90-0,93; p0.001), Killip class II and III at admission (HR 1.82; 95%CI 1.36-2.45; p=0.001), chronic kidney disease (HR 1.42; 95%CI 1.12-2.03; p=0.015) and diabetes (HR 1.35, 95%CI 1,05-1.67, p=0.052). Conclusion Unadjusted eight-year mortality following STEMI was significantly higher in women as compared with men. After adjusting for age, there was no significant difference in eight-year mortality between men and women. In multivariable analysis age, but not sex, was independently associated with long-term mortality.
Savic et al. (Fri,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=3,079). Female sex vs. Male sex was evaluated on 8-year all-cause mortality (HR 1.05, 95% CI 0.86-1.08, p=0.691). Female sex was not an independent predictor of 8-year all-cause mortality after STEMI when adjusted for age (HR 1.05; 95% CI 0.86-1.08; p=0.691), despite higher unadjusted mortality than men.