Female gender was associated with higher unadjusted in-hospital mortality compared to males (10% vs 5%) after primary PCI for STEMI, but adjusted mortality did not differ significantly.
Observational (n=1,104)
Yes
Does female gender affect adherence to guideline-recommended therapy and mortality in patients undergoing primary PCI for STEMI?
Higher unadjusted mortality in women after primary PCI for STEMI is driven by differences in baseline risk factors and lower guideline adherence (the risk-treatment paradox) rather than gender itself.
Absolute Event Rate: 10% vs 5%
BACKGROUND: It is uncertain whether gender differences in outcome after primary percutaneous coronary intervention (PCI) are only attributable to different baseline characteristics or additional factors. METHODS: Databases of two German myocardial infarction network registries were combined with a total of 1104 consecutive patients admitted with acute ST-elevation myocardial infarction (STEMI) and treated according to standardized protocols. RESULTS: Approximately 25% of patients were females. Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males. Mean prehospital delay was numerically longer in females (227 vs 209 min) as was in hospital delay (35 vs 30 min). PCI was finally performed in 92% of females and 95% of males with comparable procedural success (95% vs 97%). Use of drug eluting stents (55% vs 68%) and application of GP 2b 3a blockers (75% vs 89%) was significantly less frequent in women. At discharge, prescription of beta blockers and lipid lowering drugs was also significantly lower in females (84% vs 90% and 71% vs 84%). Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months. Adjusted mortality however did not differ significantly between genders. CONCLUSION: Higher unadjusted mortality in females after primary PCI was accompanied by significant differences in baseline characteristics, interventional approach and secondary prophylaxis in spite of the same standard of care. Lower guideline adherence seems to be less gender specific but rather a manifestation of the risk-treatment paradox.
Birkemeyer et al. (Mon,) conducted a observational in Acute ST-elevation myocardial infarction (STEMI) (n=1,104). Female gender vs. Male gender was evaluated on Unadjusted in-hospital mortality. Female gender was associated with higher unadjusted in-hospital mortality compared to males (10% vs 5%) after primary PCI for STEMI, but adjusted mortality did not differ significantly.