April 1, 2013Catheterization and Cardiovascular Interventions
Gender differences in long‐term outcome after primary percutaneous intervention for ST‐segment elevation myocardial infarction
Why the study?
Does female gender influence long-term outcomes in patients undergoing primary PCI for STEMI?
Population
870 patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial…
Comparison
Female gender (primary PCI for STEMI in women) vs Male gender (primary PCI for STEMI in men)
Design
Cohort
Follow-up
2 years
Authors
Discussion
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Member takes
Implication
Baseline risk, not gender, drives MACE differences after primary PCI; supports risk-adjusted analyses and leaves open prospective validation.
Key Points
- To assess the influence of gender on two-year clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
- Analyzed two-year follow-up data from 870 patients (202 women and 668 men) undergoing primary PCI for STEMI between January 2006 and May 2008 in the DEBATER trial database.
- Evaluated the primary composite endpoint of major adverse cardiac events (MACE), consisting of all-cause mortality, recurrent myocardial infarction, and target vessel revascularization.
- Conducted multivariate regression adjusting for age, hypertension, diabetes mellitus, smoking status, stent diameter, and symptom-onset-to-ambulance arrival time.
- Unadjusted two-year MACE was significantly higher in women than in men (21% vs. 14%; P = 0.02), as was the unadjusted mortality rate (8% vs. 2.6%; P < 0.001).
- Women had worse baseline risk profiles, being significantly older (64.7 ± 11.7 vs. 59.0 ± 10.7 years; P < 0.001) with higher prevalence of diabetes mellitus (15% vs. 9%; P = 0.01) and hypertension (44% vs. 25%; P < 0.001).
- Multivariate adjustment for age, baseline cardiovascular risk factors, stent diameter, and ischemic time eliminated the significant differences in MACE and mortality between genders.
Structured PICO
Does female gender influence long-term outcomes in patients undergoing primary PCI for STEMI?
P
Population
870 patients (202 female, 668 male) undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) between January 2006 and May 2008.
I
Intervention
Female gender (primary PCI for STEMI in women)
C
Comparator
Male gender (primary PCI for STEMI in men)
O
Outcome
Major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction, and target vessel revascularization at 2 yearscomposite
Women have higher unadjusted rates of MACE and mortality after primary PCI for STEMI compared to men, but this difference is driven by older age and higher baseline risk profiles rather than gender itself.
Cite This Study
Wijnbergen et al. (2013) studied this question.