Impact of Female Sex on Long-Term Outcomes in Patients With ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Giuseppe Ferrante, Elena Corrada, Guido Belli, Dennis Zavalloni, Melania Scatturin, Marco Mennuni, Gabriele L. Gasparini, Luisa Bernardinelli, Daniela Cianci, Roberta Pastorino, Marco L. Rossi, Paolo Pagnotta, Patrizia Presbitero

Research output: Contribution to journalArticle

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Abstract

Background: Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95% confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men. Results: Among 481 patients, median age 66 years old, 138 (28.7%) were women. Women were older than men (72 vs 63 years, P <0.001), had a higher prevalence of hypertension (68% vs 54%, P = 0.006), diabetes (27% vs 19%, P = 0.04), and Killip class ≥ 3 at admission (19% vs 10%, P = 0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9% vs 18.4%, unadjusted HR 1.86; 95% CI, 1.26-2.74; P = 0.002), driven mainly by heart failure (unadjusted HR 2.47; 95% CI, 1.12-5.41; P = 0.024), without significant differences in death (unadjusted HR 1.49; 95% CI, 0.88-2.53; P = 0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95% CI, 0.78-3.27; P = 0.19) and no increase in target lesion revascularization (9.4% vs 12.5%, unadjusted HR 0.77; 95% CI, 0.42-1.44; P = 0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95% CI, 0.84-2.06; P = 0.23). Conclusions: Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.

Original languageEnglish
Pages (from-to)749-755
Number of pages7
JournalCanadian Journal of Cardiology
Volume27
Issue number6
DOIs
Publication statusPublished - Nov 2011

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Percutaneous Coronary Intervention
Confidence Intervals
Propensity Score
Heart Failure
Myocardial Infarction
ST Elevation Myocardial Infarction
Sex Characteristics
Hospitalization
Retrospective Studies
Hypertension
Incidence
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Female Sex on Long-Term Outcomes in Patients With ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention. / Ferrante, Giuseppe; Corrada, Elena; Belli, Guido; Zavalloni, Dennis; Scatturin, Melania; Mennuni, Marco; Gasparini, Gabriele L.; Bernardinelli, Luisa; Cianci, Daniela; Pastorino, Roberta; Rossi, Marco L.; Pagnotta, Paolo; Presbitero, Patrizia.

In: Canadian Journal of Cardiology, Vol. 27, No. 6, 11.2011, p. 749-755.

Research output: Contribution to journalArticle

Ferrante, Giuseppe ; Corrada, Elena ; Belli, Guido ; Zavalloni, Dennis ; Scatturin, Melania ; Mennuni, Marco ; Gasparini, Gabriele L. ; Bernardinelli, Luisa ; Cianci, Daniela ; Pastorino, Roberta ; Rossi, Marco L. ; Pagnotta, Paolo ; Presbitero, Patrizia. / Impact of Female Sex on Long-Term Outcomes in Patients With ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention. In: Canadian Journal of Cardiology. 2011 ; Vol. 27, No. 6. pp. 749-755.
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abstract = "Background: Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95{\%} confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men. Results: Among 481 patients, median age 66 years old, 138 (28.7{\%}) were women. Women were older than men (72 vs 63 years, P <0.001), had a higher prevalence of hypertension (68{\%} vs 54{\%}, P = 0.006), diabetes (27{\%} vs 19{\%}, P = 0.04), and Killip class ≥ 3 at admission (19{\%} vs 10{\%}, P = 0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9{\%} vs 18.4{\%}, unadjusted HR 1.86; 95{\%} CI, 1.26-2.74; P = 0.002), driven mainly by heart failure (unadjusted HR 2.47; 95{\%} CI, 1.12-5.41; P = 0.024), without significant differences in death (unadjusted HR 1.49; 95{\%} CI, 0.88-2.53; P = 0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95{\%} CI, 0.78-3.27; P = 0.19) and no increase in target lesion revascularization (9.4{\%} vs 12.5{\%}, unadjusted HR 0.77; 95{\%} CI, 0.42-1.44; P = 0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95{\%} CI, 0.84-2.06; P = 0.23). Conclusions: Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.",
author = "Giuseppe Ferrante and Elena Corrada and Guido Belli and Dennis Zavalloni and Melania Scatturin and Marco Mennuni and Gasparini, {Gabriele L.} and Luisa Bernardinelli and Daniela Cianci and Roberta Pastorino and Rossi, {Marco L.} and Paolo Pagnotta and Patrizia Presbitero",
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AU - Ferrante, Giuseppe

AU - Corrada, Elena

AU - Belli, Guido

AU - Zavalloni, Dennis

AU - Scatturin, Melania

AU - Mennuni, Marco

AU - Gasparini, Gabriele L.

AU - Bernardinelli, Luisa

AU - Cianci, Daniela

AU - Pastorino, Roberta

AU - Rossi, Marco L.

AU - Pagnotta, Paolo

AU - Presbitero, Patrizia

PY - 2011/11

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N2 - Background: Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95% confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men. Results: Among 481 patients, median age 66 years old, 138 (28.7%) were women. Women were older than men (72 vs 63 years, P <0.001), had a higher prevalence of hypertension (68% vs 54%, P = 0.006), diabetes (27% vs 19%, P = 0.04), and Killip class ≥ 3 at admission (19% vs 10%, P = 0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9% vs 18.4%, unadjusted HR 1.86; 95% CI, 1.26-2.74; P = 0.002), driven mainly by heart failure (unadjusted HR 2.47; 95% CI, 1.12-5.41; P = 0.024), without significant differences in death (unadjusted HR 1.49; 95% CI, 0.88-2.53; P = 0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95% CI, 0.78-3.27; P = 0.19) and no increase in target lesion revascularization (9.4% vs 12.5%, unadjusted HR 0.77; 95% CI, 0.42-1.44; P = 0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95% CI, 0.84-2.06; P = 0.23). Conclusions: Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.

AB - Background: Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95% confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men. Results: Among 481 patients, median age 66 years old, 138 (28.7%) were women. Women were older than men (72 vs 63 years, P <0.001), had a higher prevalence of hypertension (68% vs 54%, P = 0.006), diabetes (27% vs 19%, P = 0.04), and Killip class ≥ 3 at admission (19% vs 10%, P = 0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9% vs 18.4%, unadjusted HR 1.86; 95% CI, 1.26-2.74; P = 0.002), driven mainly by heart failure (unadjusted HR 2.47; 95% CI, 1.12-5.41; P = 0.024), without significant differences in death (unadjusted HR 1.49; 95% CI, 0.88-2.53; P = 0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95% CI, 0.78-3.27; P = 0.19) and no increase in target lesion revascularization (9.4% vs 12.5%, unadjusted HR 0.77; 95% CI, 0.42-1.44; P = 0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95% CI, 0.84-2.06; P = 0.23). Conclusions: Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.

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