title: Impact of gender differences on myocardial salvage and post-ischaemic left ventricular remodelling after primary coronary angioplasty: new insights from cardiovascular magnetic resonance.
abstract: OBJECTIVE
  There is conflicting evidence on the impact of gender on reperfusion after primary coronary angioplasty (PPCI), and on left ventricular (LV) remodelling (LVR). In a cohort of patients with reperfused ST elevation myocardial infarction (STEMI), gender-related differences on myocardial reperfusion, and sex-related differences on LVR were assessed by using a comprehensive cardiac magnetic resonance (CMR) approach.
  
  
  RESULTS
  In four tertiary referral centres, 283 (238 males and 45 females) consecutive STEMI patients, treated with PPCI within 12 h from symptoms onset underwent CMR 3 ± 2 days after STEMI and at 4-month follow-up. By CMR, the area at risk, infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) were assessed. Women were older than men (P = 0.014), more hypertensive (P < 0.001) and more frequently presented with pre-infarct angina (P = 0.018). An MSI extent was significantly higher (P = 0.013), IS was significantly smaller at both time points (acute P < 0.001, follow-up P < 0.001), and the MVO extent was significantly smaller (P < 0.001) in women. At multivariate analysis, Killip class and female sex were independently associated with a higher MSI (P = 0.02, P = 0.05, respectively). A similar incidence of LVR in both sexes was observed at follow-up (P = 0.808).
  
  
  CONCLUSIONS
  The better reperfusion pattern observed in women by CMR in our population of reperfused STEMI suggests sex-based differences exist. No gender differences were observed with respect to incidence of LV remodelling at the follow-up mainly occurring in the subset of patients with a larger IS.
authors.affiliation: Department of Cardiology, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Canali
authors.forename: Pier
authors.initials: P
authors.lastname: Masci
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli Ducci
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Elisa
authors.initials: E
authors.lastname: McAlindon
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Walter
authors.initials: W
authors.lastname: Desmet
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
mesh_terms: D000367:Age Factors; D000375:Aging; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006305:Health Status Indicators; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D015425:Myocardial Reperfusion; D009206:Myocardium; D011446:Prospective Studies; D012737:Sex Factors; D013223:Statistics as Topic; D013997:Time Factors; D014463:Ultrasonography; D020257:Ventricular Remodeling