January 26, 2019Coronary Artery Disease

Long-term outcomes in men and women with ST-segment elevation myocardial infarction and incomplete reperfusion after a primary percutaneous coronary intervention

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Why the study?

Reperfusion therapy failure in STEMI is more frequent than previously considered, prompting evaluation of sex-related differences in long-term outcomes after incomplete infarct-related artery reperfusion.

Does female sex independently impact long-term mortality in patients with STEMI and incomplete reperfusion after primary PCI?

Structured PICO

Does female sex independently impact long-term mortality in patients with STEMI and incomplete reperfusion after primary PCI?

Population

2,219 patients (766 women, 1453 men) with ST-segment elevation myocardial infarction (STEMI) and incomplete infarct-related artery reperfusion (TIMI flow grade <3) after primary percutaneous coronary intervention, drawn from a larger cohort of 42,752 STEMI patients hospitalized between 2009 and 2011 in Poland.

Intervention

Female sex

Comparator

Male sex

Outcome

Long-term mortality at 2-year follow-uphard clinical

While women with STEMI and incomplete reperfusion after primary PCI have higher crude mortality and heart failure rates than men, this difference is driven by baseline clinical characteristics such as advanced age rather than sex itself.

Implication

Women with incomplete reperfusion after STEMI had higher mortality; leaves open whether sex-specific strategies improve outcomes.

Abstract

BACKGROUND: The failure of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) is more frequent than considered previously. AIM: To evaluate sex-related differences in long-term outcomes in patients with STEMI and incomplete infarct-related artery reperfusion after a primary percutaneous coronary intervention. PATIENTS AND METHODS: Of consecutive 42 752 patients with STEMI hospitalized between 2009 and 2011 in Poland, we analyzed a group of 766 (35%) women and 1453 (65%) men with less than thrombolysis in myocardial infarction (TIMI) flow grade 3 following a primary percutaneous coronary intervention. RESULTS: In the 2-year follow-up, the mortality rate among women was significantly higher compared with men: 39.8 versus 30.9% (P=0.0009) in the TIMI 0 or 1 group, and 31.6 versus 20% (P<0.0001) in the TIMI 2 group. In women, the risk of rehospitalization because of heart failure was significantly higher irrespective of the final TIMI flow grade. In the multivariate analysis, female sex did not influence both in-hospital (odds ratio: 1.09; 95% confidence interval: 0.82-1.44; P=0.54) and long-term (hazard ratio: 1.14; 95% confidence interval: 0.97-1.34; P=0.11) mortality. Peripheral artery disease, anterior myocardial infarction, and previous stroke were associated with increased mortality only in men. Postprocedural TIMI flow grade 2 (vs. TIMI grade 0 or 1) was the strongest factor impacting mortality irrespective of sex. CONCLUSION: Women with STEMI and postprocedural suboptimal epicardial blood flow have higher mortality than men and are at high risk of developing heart failure, with frequent in-patient visits. However, these differences may be attributed to the advanced age and worse clinical presentation of women compared with men.