Female gender is an independent predictor of in-hospital mortality after STEMI in the era of primary PCI: insights from the greater Paris area PCI Registry

Abstract

Aims: To determine if female gender is an independent predictor of in-hospital mortality after percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). A higher early mortality rate after STEMI has been reported in women before the widespread use of PCI in STEMI. PCI improves the prognosis of STEMI, however, the effect of PCI in women in this setting is controversial. In a large regional prospective registry, we examined the in-hospital mortality after PCI for STEMI.

Methods and results: The greater Paris area comprises 11 million inhabitants. Data from all PCIs performed in 41 centres is entered in a mandatory registry. In-hospital mortality is recorded in another hospital-based database. From 2003 to 2007, 16,760 patients were treated by PCI for STEMI <24 hours; 21.9% were women. Female patients were significantly older than men, 69.7 ± 14.3 years versus 59.3 ± 13.0 years (p<0.0001). The rate of diabetes mellitus and cardiogenic shock were significantly higher in women versus men, respectively 19.0% versus 15.6%, p<0.0001 and 6.7% versus 4.0%, p<0.0001. The success rate of PCI was significantly lower in women: 94.7% versus 95.9%, p=0.002. In-hospital mortality was significantly higher in women 9.8 % versus 4.3%, p<0.0001 and the impact of gender on mortality was significant only after the age of 75. By multivariate analysis, female gender is associated with higher in-hospital mortality.

Conclusions: After PCI for STEMI, female gender is still an independent predictor of in-hospital mortality.