Key result
Female gender does not independently predict death after primary PCI for STEMI despite higher absolute mortality.
Why the study?
Higher mortality is reported among women with STEMI undergoing primary PCI, but differences in clinical profiles and outcomes by gender require evaluation.
Does female gender affect in-hospital mortality in patients with STEMI undergoing primary PCI?
Observational (n=208)
No
Does female gender affect in-hospital mortality in patients with STEMI undergoing primary PCI?
Absolute Event Rate: 23.5% vs 8.9%
p-value: p=0.006
Although women with STEMI undergoing primary PCI have higher in-hospital mortality than men, this difference appears to be driven by older age and clinical severity rather than female gender itself.
Gender differences in STEMI pPCI outcomes should not yet alter practice; leaves open whether disparities reflect confounders in this retrospective cohort.
Background Higher mortality is reported among women with ST-elevation myocardial infarction (STEMI). This study aimed to evaluate the clinical and angiographic profiles, as well as outcomes of patients submitted to primary percutaneous coronary intervention (pPCI), according to gender. Methods Retrospective study that included patients with STEMI undergoing pPCI between March 2012 and May 2013 at a regional referral center, followed from admission until hospital discharge or death. Results 208 patients underwent pPCI, of whom 51 (24.5%) were women and 157 (75.5%) men. A significant difference was observed for age (65.5 ± 14.0 vs. 58.8 ± 11.0 years; p = 0.001), diabetes (43.1% vs. 24.8%; p = 0.02), Killip-Kimball class III/IV (7.0% vs. 17.6%; p = 0.02), pain-to-door time (181 ± 154 minutes vs. 125 ± 103 minutes; p = 0.004), and door-to-balloon time (181 ± 87 vs. 133 minutes ± 67 minutes; p = 0.001). The success of the procedure was similar (92.1% vs. 91.1%; p = 0.22). In-hospital mortality was higher for females (23.5% vs. 8.9%; p = 0.006). Multivariate analysis identified age ≥ 70 years (odds ratio - OR = 2.75; 95% confidence interval - 95% CI: 1.81–3.64; p = 0.029) and Killip-Kimball class III/IV (OR = 2.45; 95% CI: 1.49–4.02; p = 0.002) as independent predictors of mortality. Conclusions Women with STEMI had a more severe clinical profile and longer pain-to-door and door-to-balloon times than men. Females had higher in-hospital mortality after pPCI, but the female gender was not identified as an independent predictor of death.
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Barbosa et al. (2015) conducted an observational in ST-elevation myocardial infarction (n=208). Female gender vs. Male gender was evaluated on In-hospital mortality (p=0.006). Although women with STEMI undergoing primary PCI had higher in-hospital mortality than men (23.5% vs. 8.9%; p=0.006), female gender was not an independent predictor of death.
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