Key result
Female gender was associated with a significantly smaller infarct size (mean difference 5.1% of LV) and higher myocardial salvage index compared to men following ST-elevation myocardial infarction.
Why the study?
Infarct evolution rate and response to acute reperfusion therapy may differ between patients, which is important for accurate management and treatment of STEMI patients.
Does gender, smoking status, diabetes, or hypertension affect infarct size and myocardial salvage in patients with first-time STEMI?
Cohort (n=301)
Yes
Does gender, smoking status, diabetes, or hypertension affect infarct size and myocardial salvage in patients with first-time STEMI?
In patients with first-time STEMI, female gender is associated with higher myocardial salvage and smaller infarct size compared to men, whereas diabetes, hypertension, and smoking showed no significant effects.
Women had greater myocardial salvage independent of risk factors; leaves open whether sex-specific STEMI management warrants prospective validation.
BACKGROUND: Infarct evolution rate and response to acute reperfusion therapy may differ between patients, which is important to consider for accurate management and treatment of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was therefore to investigate the association of infarct size and myocardial salvage with gender, smoking status, presence of diabetes or history of hypertension in a cohort of STEMI-patients. METHODS: Patients (n = 301) with first-time STEMI from the three recent multi-center trials (CHILL-MI, MITOCARE and SOCCER) underwent cardiac magnetic resonance (CMR) imaging to determine myocardium at risk (MaR) and infarct size (IS). Myocardial salvage index (MSI) was calculated as MSI = 1-IS/MaR. Pain to balloon time, culprit vessel, trial treatments, age, TIMI grade flow and collateral flow by Rentrop grading were included as explanatory variables in the statistical model. RESULTS: Women (n = 66) had significantly smaller MaR (mean difference: 5.0 ± 1.5% of left ventricle (LV), p < 0.01), smaller IS (mean difference: 5.1 ± 1.4% of LV, p = 0.03), and larger MSI (mean difference: 9.6 ± 2.8% of LV, p < 0.01) compared to men (n = 238). These differences remained significant when adjusting for other explanatory variables. There were no significant effects on MaR, IS or MSI for diabetes, hypertension or smoking. CONCLUSIONS: Female gender is associated with higher myocardial salvage and smaller infarct size suggesting a pathophysiological difference in infarct evolution between men and women.
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Nordlund et al. (2019) conducted a cohort in ST-elevation myocardial infarction (n=301). Female gender vs. Male gender was evaluated on Infarct size (% of left ventricle) (MD 5.1%, p=0.03). Female gender was associated with a significantly smaller infarct size (mean difference 5.1% of LV) and higher myocardial salvage index compared to men following ST-elevation myocardial infarction.
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