Gender and myocardial salvage after reperfusion treatment in acute myocardial infarction.
OBJECTIVE
The aim of this study was to investigate whether there are gender-associated differences in the amount of myocardial salvage after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).


BACKGROUND
Despite having a more adverse cardiovascular risk profile, women with AMI have similar or even better outcomes after primary PCI compared with men. The reasons for these findings are unclear.


METHODS
In this study we included 202 women and 561 men with AMI who underwent primary PCI in the setting of three randomized trials. The primary end point of the study was myocardial salvage index (proportion of initial perfusion defect salvaged by reperfusion therapy), obtained by paired scintigraphic studies performed 7 to 10 days apart.


RESULTS
The amount of myocardium at risk or initial perfusion defect (median [25th, 75th percentiles]) did not differ significantly between women and men (22.0% [12.0, 40.0] vs. 24.0% [14.0, 39.0] of the left ventricle [LV], p = 0.26). Final infarct size, measured in the follow-up scintigraphy, was significantly smaller in women than in men (6.0% [0.71, 18.7] vs. 10.0% [3.9, 21.8] of the LV, p = 0.001). Myocardial salvage index was 0.64 (0.35, 0.95) in women versus 0.50 (0.26, 0.77) in men (p < 0.001). After adjustment for baseline characteristics, female gender was an independent predictor of greater myocardial salvage after PCI (p = 0.002).


CONCLUSIONS
The efficacy of primary PCI in patients with AMI appears to be gender-dependent. Myocardial salvage achieved by primary PCI is greater in women than in men.
Mehilli
Julinda
J
Deutsches Herzzentrum, Technischen Universität, Munich, Germany. mehilli@dhm.mhn.de
Ndrepepa
Gjin
G
Kastrati
Adnan
A
Nekolla
Stephan G
SG
Markwardt
Christina
C
Bollwein
Hildegard
H
Pache
Jürgen
J
Martinoff
Stefan
S
Dirschinger
Josef
J
Schwaiger
Markus
M
Schömig
Albert
A
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome