title: Short-term prognosis of contemporary interventional therapy of ST-elevation myocardial infarction: does gender matter?
abstract: BACKGROUND
  A higher mortality risk for women with acute ST-elevation myocardial infarction (STEMI) has been a common finding in the past, even after acute percutaneous coronary intervention (PCI). We set out to analyze whether there are gender differences in real-world contemporary treatment and outcomes of STEMI.
  
  
  METHODS
  A retrospective analysis of all consecutive patients with STEMI and acute coronary angiography with the intention of performing a PCI at our center 6/1999-6/2006 was carried out (n = 566). Data were examined for gender-specific differences regarding patients' characteristics, referral patterns, timing of acute symptoms, angiographic findings, procedural details, and adverse events at 30 days after PCI.
  
  
  RESULTS
  Women (n = 161) were on average 8 years older than men (n = 405), had higher co-morbidity, were more often transported to the hospital by ambulance and presented less often to the emergency room on their own (4.2% vs. 12.6% in men, P = 0.02). The pre-hospital delay from symptom onset to admission was significantly longer for women (median 185 vs. 135 min, P < 0.02). There was no gender difference in time from admission to PCI (median 46 min vs. 48 min, P = 0.42). Both genders received PCI with similar frequency (88.8% vs. 92.4%, P = 0.19), with similar success rates (83.2% vs. 85.3%, P = 0.68). Thirty-day overall mortality for women was not significantly higher than for men (8.7% vs. 7.2%, P = 0.6). Re-infarction or stroke within 30 days were rare for both genders without gender-specific differences whereas bleeding necessitating blood replacement was significantly more frequent in women (16.8% vs. 5.9%, P < 0.001). In multivariate analysis, female gender was not independently associated with a higher risk of 30-day mortality (OR 0.964, P = 0.93).
  
  
  CONCLUSIONS
  Women underwent PCI therapy for STEMI with the same frequency and the same angiographic success as men. Despite their more advanced age and the higher prevalence of co-morbidities, they did not have a significantly higher 30-day mortality rate than men. Female gender was not an independent risk factor of 30-day mortality. Longer pre-hospital delays before hospital admission in women indicate that awareness of risk from coronary artery disease should be further raised in women.
authors.affiliation: Medizinische Klinik 2 (Kardiologie/Angiologie), Universitätsklinikum Erlangen, 91054 Erlangen, Germany. stefan.zimmermann@uk-erlangen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmermann
authors.forename: Susanne
authors.initials: S
authors.lastname: Ruthrof
authors.forename: Kathrin
authors.initials: K
authors.lastname: Nowak
authors.forename: Anna
authors.initials: A
authors.lastname: Alff
authors.forename: Lutz
authors.initials: L
authors.lastname: Klinghammer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schneider
authors.forename: Josef
authors.initials: J
authors.lastname: Ludwig
authors.forename: Annette B
authors.initials: AB
authors.lastname: Pfahlberg
authors.forename: Werner G
authors.initials: WG
authors.lastname: Daniel
authors.forename: Frank A
authors.initials: FA
authors.lastname: Flachskampf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
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