Worse prognosis for women who underwent primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.
BACKGROUND
Many reports have shown that female gender carries a worse prognosis when developing acute myocardial infarction (MI), whether or not reperfusion therapy is used. The primary percutaneous coronary intervention (1-PCI) is currently a preferable treatment for acute ST-elevation MI. However, the data concerning the difference between the outcomes in the treatment of the disease in men and women in Thailand is still insufficient.


METHODS
A prospective registry of acute ST-elevation MI patients who underwent 1-PCI at King Chulalongkorn Memorial Hospital from June 1999 to December 2002 were analyzed. Kaplan Meier survival analysis is used to determine the in-hospital mortality.


RESULTS
The consecutive 184 (F-52, M-131) patients who underwent 1-PCI were recruited. Female subjects were older (66.6 +/- 12 y versus 59.0 +/- 11.6 y, p < 0.01); they also had higher percentage of diabetes (45.1 versus 27.1, p < 0.01), but a fewer number of smoker (17.7 versus 66.2, p < 0.001). The percentage of patients who had cardiogenic shock tended to be higher in women (34.6 versus 19.9, p = 0.08); however, the number of anterior wall MI and ejection fraction were not different. The mean door to balloon time (109 +/- 95 versus 99 +/- 68 minutes) and pain to balloon time (454 +/- 271 versus 372 +/- 298 minutes) were not different in both groups. The angiographic success with TIMI 3 flow was achieved in 92.3% for females and 86.9% for the males. The in-hospital mortality was significantly higher in females (23.1 versus 6.1, p = 0.002). Univariate analyses demonstrated that the feminine gender, cardiogenic shock, smoking, ejection fraction less than 40, cardiac arrest prior PCI and angiographic were the predictors for in-hospital mortality. When using multivariate analyses by Cox proportional model, only cardiogenic shock, history of hypertension and angiographic success were the significant predictors. Women had 2.15 times of in-hospital mortality higher than males; however, the confidence interval cross-over 1 (0.74-6.42) and p value was 0.16.


CONCLUSIONS
Females tend to have a poor prognosis when they develop acute ST-elevation MI which requires treatment with 1-PCI.
Srimahachota
Suphot
S
Cardiac center and Division of Cardiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. trcssmc@md2.md.chula.ac.th
Boonyaratavej
Smonporn
S
Udayachalerm
Wasan
W
Buddhari
Wacin
W
Chaipromprasit
Jarkarpun
J
Suithichaiyakul
Taworn
T
Sukseri
Yeesune
Y
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012737:Sex Factors; D016019:Survival Analysis; D013785:Thailand