Gender disparity in 48-hour mortality is limited to emergency percutaneous coronary intervention for ST-elevation myocardial infarction.
BACKGROUND
Previous studies indicate that mortality from acute coronary syndromes is higher in women than in men, especially in case of interventional strategy.


OBJECTIVE
To assess whether the in-hospital mortality rate differs between genders during the first 48h after emergency percutaneous coronary intervention for ST-elevation myocardial infarction (emergency PCI-STEMI) or after non-emergency PCI.


METHODS
All patients treated with PCI between January 2005 and June 2008 were included. The primary endpoint was frequency of death within 48h after the PCI procedure; secondary endpoints included frequency of recurrent myocardial infarction, new PCI or coronary artery bypass graft surgery, stroke, and major vascular or renal complications. Data were analysed via logistic regression with and without propensity-score matching.


RESULTS
More than 9000 patients underwent PCI. In the emergency PCI-STEMI group (n=1753), 48-hour mortality occurred in 2.2% of men and 4.9% of women (p=0.004). However, gender disparity occurred only in elderly patients; the rate was significantly (p=0.02) higher in women (8.1%) than in men (3.3%) aged > or =75 years. There was no evidence of gender disparity in the non-emergency PCI group (n=7336) or in secondary endpoints for either PCI group. Similar results were obtained in pair analyses of men and women with matching propensity scores.


CONCLUSIONS
Elderly women have a disproportionately high in-hospital mortality rate during the first 48h after emergency PCI for treatment of STEMI; however, there is no gender discrepancy in younger patients or patients of any age who receive non-emergency procedures.
Roncalli
Jérôme
J
Department of Cardiology, Rangueil University Hospital, Toulouse, France. roncalli.j@chu-toulouse.fr
Elbaz
Meyer
M
Dumonteil
Nicolas
N
Boudou
Nicolas
N
Lairez
Olivier
O
Lhermusier
Thibault
T
Chilon
Talia
T
Baixas
Cécile
C
Galinier
Michel
M
Puel
Jacques
J
Fauvel
Jean-Marie
JM
Carrié
Didier
D
Ruidavets
Jean-Bernard
JB
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D054624:Health Status Disparities; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome