title: In-hospital management and outcome in women with acute myocardial infarction (data from the AMI-Florence Registry).
abstract: Primary percutaneous coronary intervention proved to be superior to thrombolysis in reducing ST-segment elevation acute myocardial infarction (STEAMI) mortality. However, whether such benefit is similar in women and men remains unclear. The aim of the present analysis was to assess the independent effect of female gender on management and on early and 1-year mortality in Florence, Italy, where primary percutaneous coronary intervention is the preferred reperfusion strategy for STEAMI. The study included a cohort of 920 unselected patients with STEAMI (men = 627, women = 293) prospectively enrolled in the AMI-Florence, population-based registry over 12 months. Women were older (76 vs 68 years, p <0.001) and more frequently had Killip class >I heart failure than men. The median delay to hospital admission was marginally longer in women (160 vs 130 minutes, p = 0.09). Coronary reperfusion treatment was performed less often in women (49% vs 58%, p <0.013); primary percutaneous coronary intervention was performed more often in both genders (90% vs 91%) and with similar median door-to-balloon time (50 vs 45 minutes, p = 0.44). Both in-hospital (16% vs 8%, p <0.001) and 1-year mortality (25% vs 18%, p = 0.016) were higher in women. However, after adjusting for age and other baseline characteristics, reperfusion treatment (odds ratio 1.27, 95% confidence interval [CI] 0.78 to 2.08) and 1-year mortality (hazard ratio [HR] 0.91, 95% CI 0.67 to 1.24) were independent of female gender. Compared with conservative therapy, reperfusion treatment was associated with a similar reduction in 1-year mortality in women (HR 0.59, 95% CI 0.34 to 1.02) and men (HR 0.58, 95% CI 0.37 to 0.92). Our data suggest that older age and several age-related factors may largely account for the higher mortality of women after STEAMI. Even in the general population,improvement in prognosis associated with reperfusion treatment is independent of gender.
authors.affiliation: Cardiology Unit 1, Azienda Ospedaliera Careggi, Florence, Italy. carddept@tin.it
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Santoro
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Plinio
authors.initials: P
authors.lastname: Fabiani
authors.forename: Cristina
authors.initials: C
authors.lastname: Landini
authors.forename: Luca
authors.initials: L
authors.lastname: Scarti
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Valerio
authors.initials: V
authors.lastname: Verdiani
authors.forename: Eva
authors.initials: E
authors.lastname: Buiatti
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D015425:Myocardial Reperfusion; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D016387:Women's Health
chemical_list: D000319:Adrenergic beta-Antagonists; D019039:Platelet Glycoprotein GPIIb-IIIa Complex