title: Impact of female sex on long-term outcomes in patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention.
abstract: BACKGROUND
  Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  This retrospective study enrolled consecutive patients with ST-elevation myocardial infarction undergoing primary PCI within 24 hours from symptom onset. Hazard ratios (HRs) of events with 95% confidence interval (CI) were calculated in the overall population and in a propensity score matched cohort of women and men.
  
  
  RESULTS
  Among 481 patients, median age 66 years old, 138 (28.7%) were women. Women were older than men (72 vs 63 years, P<0.001), had a higher prevalence of hypertension (68% vs 54%, P=0.006), diabetes (27% vs 19%, P=0.04), and Killip class≥3 at admission (19% vs 10%, P=0.007). After a median follow-up of 1041 days women experienced a significant higher incidence of the composite of death, nonfatal myocardial infarction, and hospitalization for heart failure (31.9% vs 18.4%, unadjusted HR 1.86; 95% CI, 1.26-2.74; P=0.002), driven mainly by heart failure (unadjusted HR 2.47; 95% CI, 1.12-5.41; P=0.024), without significant differences in death (unadjusted HR 1.49; 95% CI, 0.88-2.53; P=0.13), or nonfatal myocardial infarction (unadjusted HR 1.59; 95% CI, 0.78-3.27; P=0.19) and no increase in target lesion revascularization (9.4% vs 12.5%, unadjusted HR 0.77; 95% CI, 0.42-1.44; P=0.42). After propensity score matching the hazard of the composite endpoint was largely attenuated (HR 1.32; 95% CI, 0.84-2.06; P=0.23).
  
  
  CONCLUSIONS
  Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.
authors.affiliation: Department of Interventional Cardiology, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy. giu.ferrante@hotmail.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.forename: Elena
authors.initials: E
authors.lastname: Corrada
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.forename: Dennis
authors.initials: D
authors.lastname: Zavalloni
authors.forename: Melania
authors.initials: M
authors.lastname: Scatturin
authors.forename: Marco
authors.initials: M
authors.lastname: Mennuni
authors.forename: Gabriele L
authors.initials: GL
authors.lastname: Gasparini
authors.forename: Luisa
authors.initials: L
authors.lastname: Bernardinelli
authors.forename: Daniela
authors.initials: D
authors.lastname: Cianci
authors.forename: Roberta
authors.initials: R
authors.lastname: Pastorino
authors.forename: Marco L
authors.initials: ML
authors.lastname: Rossi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pagnotta
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors