title: Gender differences in epicardial and tissue-level reperfusion in patients undergoing primary angioplasty for acute myocardial infarction.
abstract: OBJECTIVE
  The impact of gender on clinical course after ST-elevation myocardial infarction (STEMI) is not fully understood. We prospectively investigated whether there are gender-related differences in epicardial and myocardial tissue-level perfusion, both of which represent important prognostic determinants in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
  
  
  METHODS
  A total of 594 consecutive non-selected STEMI patients undergoing PPCI were prospectively enrolled. Primary end-point of the study was post-procedural epicardial and myocardial perfusion. Secondary end-points were the 30-day and 6-month composite occurrence of major adverse cardiac events (MACE).
  
  
  RESULTS
  Women with STEMI had higher risk factor profiles than men. Although PPCI achieved equal rates of successful epicardial reperfusion, women tended to have impaired microvascular reperfusion as reflected by lower rates of normal TIMI myocardial perfusion grade (P=0.007) and complete ST-segment resolution (P=0.079). After adjustment for the risk profiles, multivariable analysis showed that gender itself was not an independent predictor of impaired microvascular reperfusion. Both female gender and impaired myocardial reperfusion were independent predictors of 30-day MACE, whereas gender lost its prognostic significance for 6-month MACE. Multivariable analysis restricted to female patients identified incomplete ST-segment resolution as the strongest determinant of 30-day MACE.
  
  
  CONCLUSIONS
  The differences in microvascular reperfusion after PPCI between women and men are attributed to higher risk profiles in women. Both female gender and impaired myocardial reperfusion were independent predictors of 30-day outcomes after PPCI, emphasizing the importance of successful microvascular reperfusion in the women with STEMI.
authors.affiliation: Department of Cardiology, Shanghai Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Pu
authors.forename: Peiren
authors.initials: P
authors.lastname: Shan
authors.forename: Song
authors.initials: S
authors.lastname: Ding
authors.forename: Zhiqin
authors.initials: Z
authors.lastname: Qiao
authors.forename: Lisheng
authors.initials: L
authors.lastname: Jiang
authors.forename: Wei
authors.initials: W
authors.lastname: Song
authors.forename: Yongping
authors.initials: Y
authors.lastname: Du
authors.forename: Jieyan
authors.initials: J
authors.lastname: Shen
authors.forename: Linhong
authors.initials: L
authors.lastname: Shen
authors.forename: Shuxuan
authors.initials: S
authors.lastname: Jin
authors.forename: Ben
authors.initials: B
authors.lastname: He
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome