title: Relationship of female sex to outcomes after myocardial infarction with persistent total occlusion of the infarct artery: analysis of the Occluded Artery Trial (OAT).
abstract: BACKGROUND
  Long-term follow-up (up to 9 years) from the OAT allows for the examination of sex differences in outcomes and the effect of percutaneous coronary intervention (PCI) in a relatively homogeneous cohort of myocardial infarction (MI) survivors.
  
  
  METHODS
  The OAT randomized 484 (22%) women and 1717 men to PCI of the occluded infarct-related artery vs medical therapy alone >24 hours post-MI. There was no benefit of PCI on the composite of death, MI, and class IV heart failure. We analyzed outcomes by sex and investigated for sex-based trial selection bias using a concurrent registry.
  
  
  RESULTS
  Women were older and more likely to have left anterior descending infarct-related artery, diabetes and hypertension, history of heart failure, and rales at randomization but were less likely to smoke. The proportion and characteristics of women enrolled in the trial and the registry were similar, including left ventricular ejection fraction and extent of disease. Women had higher rates of the primary composite (hazard ratio [HR] 1.48, P = .0002), death (HR 1.50, P = .001), and heart failure (HR 2.53, P < .0001) but not reinfarction (HR 1.12, P = .57). Female sex was not independently associated with the primary end point or death on multivariate analysis. There was a trend toward independent association of female sex with heart failure (HR 1.66, P = .02).
  
  
  CONCLUSIONS
  Women in OAT had a higher primary end point event rate than did men, mainly driven by heart failure. Female sex was not independently associated with death or MI in this well-defined cohort with comparable extent of coronary artery disease, similar medical therapy, and equivalent left ventricular ejection fraction by sex.
authors.affiliation: Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, USA. harmony.reynolds@nyumc.org
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Forman
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tamis-Holland
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: Camille A
authors.initials: CA
authors.lastname: Pearte
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.forename: Krystyna
authors.initials: K
authors.lastname: Loboz-Grudzien
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D023921:Coronary Stenosis / Q000150:complications* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology