The influence of gender on short- and long-term outcome after primary PCI and delivered medical care for ST-segment elevation myocardial infarction

Abstract

Aims: Despite the advances in treatment for acute ST-elevation myocardial infarction (STEMI) during the past decades for both men and women, most previous studies reported on significantly higher unadjusted in-hospital and long-term mortality rates among women compared with men. Most of these studies have been performed in the (pre-)thrombolytic and early post-thrombolytic era. Many studies reported on myocardial infarction or acute coronary syndromes and did not specifically address STEMI. Moreover, the association of gender, quality of care and mortality has not been systematically assessed.

Methods and results: Early as well as long-term clinical outcome and delivered quality care was evaluated in an unselected cohort of 3,277 (2,367 men and 910 women) consecutive STEMI patients treated by primary PCI in a tertiary referral institution between January 1995 and 2006. Mean follow-up was 3.2+/-2.2 years. The unadjusted early and late hazards of mortality were not significantly different between men and women (30-days HR 0.87; 95%CI 0.67-1.12; 3-year HR 0.87; 95%CI 0.71-1.10), despite more adverse clinical characteristics in women. Gender was not an independent predictor for mortality and adjustment for covariates did not alter these results. Quality of care was similar between both sexes.

Conclusions: Despite higher age and more disadvantageous clinical characteristics, unadjusted early as well as long-term mortality in women with STEMI treated by primary PCI was equal compared with men. Women have longer ischaemic times compared with men but not due to a difference in delivered care. Quality of care before, during and after reperfusion was equal for men and women.