What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=4379). Intervention: Female sex vs. Male sex. Primary outcome: All-cause death (HR 0.94, 95% CI 0.71-1.24, p=0.66).

January 1, 2013Open Access

Sex-Based Differences in Clinical Practice and Outcomes for Japanese Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

TTToshiaki ToyotaKobe City Medical Center General Hospital YFYutaka FurukawaInterventional Cardiology NENatsuhiko EharaKobe City Medical Center General Hospital

Key Result

Although unadjusted 3-year all-cause mortality was higher in women than men (17.7% vs. 10.7%), the adjusted risk for all-cause death was comparable between sexes (HR 0.94).

Study Design

Type

Observational (n=4,379)

Multicenter

Yes

Structured PICO

Does female sex affect clinical outcomes and practice patterns in Japanese patients undergoing primary PCI for acute myocardial infarction compared to male sex?

Population

4,379 Japanese patients with acute myocardial infarction undergoing primary percutaneous coronary intervention, followed for a median of 3.0 years.

Exposure

Female sex

Comparator

Male sex

Outcome

In-hospital mortality and all-cause death at 3 yearshard clinical

In Japanese patients undergoing primary PCI for AMI, women have higher unadjusted mortality due to factors like older age and longer onset-to-balloon times, but adjusted mortality risk is comparable to men.

Main Result

Hazard Ratio: 0.94 (95% CI 0.71–1.24)

Absolute Event Rate: 17.7% vs 10.7%

p-value: p=0.66

Limitations

Data for blood tests, smoking habit and medical therapies were only assessed at 1 time point.
Database did not include detailed information of patients' clinical histories such as the presence of pre-infarction angina.
Indications for revascularization therapies were not defined but depended on the decision of each attending physician.
Prehospital information was not assessed.

Abstract

Background: Limited data are available for sex-based differences in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods and Results: The study patients comprised 1,197 women and 3,182 men who underwent primary PCI for AMI in 2005–2007. Compared with the men, the women were significantly older, and had significantly longer onset-to-balloon time and lower rate of follow-up coronary angiography. In-hospital mortality was higher among women than men (8.7% vs. 4.9%, P<0.001). Although the cumulative incidence of all-cause death at 3 years was also higher for women (17.7% vs. 10.7%, P<0.001), the adjusted risk for all-cause death was comparable hazard ratio (HR, women vs. men)=0.94, 95% confidence interval (CI): 0.71–1.24, P=0.66. The incidence (12.1% vs. 12.4%, P=0.77) and the adjusted risk (HR=0.99, 95% CI 0.78–1.24, P=0.92) for any clinically-driven coronary revascularization were both comparable. However, regarding any non-clinically-driven coronary revascularization, the incidence (19.6% vs. 27.8%, P<0.001) and the adjusted risk (HR=0.79, 95% CI 0.65–0.95, P=0.012) were both lower in women relative to men. Conclusions: In current Japanese clinical practice for AMI, onset-to-balloon time was significantly longer in women than in men. Female sex was associated with lower follow-up coronary angiography rate and lower incidence of any non-clinically-driven coronary revascularization, whereas the incidence of any clinically-driven coronary revascularization was comparable between the sexes. (Circ J 2013; 77: 1508–1517)

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