Key result
Women show no difference in STEMI PCI mortality versus matched men, reflecting baseline clinical profiles.
Why the study?
Conflicting evidence exists regarding gender-based differences in outcomes after primary PCI for STEMI.
Does female gender affect in-hospital mortality in patients with STEMI undergoing primary PCI?
Cohort (n=2,400)
No
Does female gender affect in-hospital mortality in patients with STEMI undergoing primary PCI?
Absolute Event Rate: 3.8% vs 3.6%
p-value: p=0.855
Gender-based differences in primary PCI outcomes for STEMI appear to be driven by baseline clinical profiles rather than gender itself, as propensity-matched in-hospital mortality is similar between men and women.
Women with STEMI show higher-risk profiles but similar adjusted primary PCI mortality; hypothesis-generating for risk-factor targeting while leaving practice change open.
Objectives: A conflict of evidence exists regarding the gender-based differences in outcomes after primary percutaneous coronary intervention (PCI), therefore, aim of this study was to compare the clinical characteristics, angiographic findings, and outcome of primary PCI for men and women. Methodology: Data for this study was extracted from a prospectively managed primary PCI database of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. We included consecutive patients of either gender with STEMI undergone primary PCI. Data on clinical characteristics, angiographic finding, and post procedure outcomes for female were compared with male group and also with a propensity matched male cohort. Results: A total of 2400 patients were included with 421(17.5%) women. The mean age for the men and women were 54.44±11.16 and 57.17±11.01 years respectively; p<0.001. Women had significantly high prevalence of hypertension (61.0% vs. 39.1%; p<0.001), diabetes (37.1% vs. 23.9%; p<0.001), and obesity (18.5% vs. 13.5%; p=0.008). The median symptom onset to hospital arrival time was 216 [366-124] minutes vs. 180 [310-112] minutes; p=0.001 for women and men. In-hospital mortality rate was 3.8% vs. 2.5%; p=0.147 for female and unmatched male cohort, while it was 3.6% vs. 3.8%; p=0.855 for female and propensity matched male cohort. Conclusion: Gender-based differences persist in clinical profile of the patients with STEMI. Women are likely to be older in age with more diabetes, hypertension, and obesity. Gender-based difference in outcome of primary PCI is appears to be driven by differences in clinical profile as adjusted outcome is not different for men and women.
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Afaque et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=2,400). Female gender vs. Male gender was evaluated on In-hospital mortality (propensity-matched) (p=0.855). In-hospital mortality after primary PCI for STEMI was not significantly different between women and a propensity-matched cohort of men (3.8% vs. 3.6%, p=0.855), indicating that apparent gender differences are driven by baseline clinical profiles.
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