title: Higher mortality in women after ST-segment elevation myocardial infarction in very young patients.
abstract: BACKGROUND
  Data on mortality in young patients with ST-segment elevation myocardial infarction (STEMI) when compared to older people or regarding therapeutic strategies are contradictory. We investigate the prognosis of women under 40 after STEMI in a prospective nationwide acute coronary syndrome registry.
  
  
  METHODS
  We analyzed all 527 consecutive men and women (12.3% females) aged from 20 to 40 years (mean 35.7 ±4.5) presenting with STEMI, of all 26035 STEMI patients enrolled.
  
  
  RESULTS
  Differences between genders in the major cardiovascular risk factors, clinical presentation, extent of the disease and time to reperfusion were insignificant. The majority of patients (67%) underwent coronary angiography followed by primary percutaneous coronary intervention (PCI) in 79.9% of them. A 92% reperfusion success rate measured by post-procedural TIMI 3 flow was achieved. There were no significant differences between genders in the administration of modern pharmacotherapy both on admission and after discharge from hospital. In-hospital mortality was very low in both genders, but 12-month mortality was significantly higher in women (10.8% vs. 3.0%; p = 0.003). Killip class 3 or 4 on admission (95% CI 19.6-288.4), age per 5-year increase (95% CI 1.01-3.73) and primary PCI (95% CI 0.1-0.93) affected mortality. In patients who underwent reperfusion there was moderately higher mortality in women than in men (7.1% vs. 1.9%; p = 0.046).
  
  
  CONCLUSIONS
  Despite little difference in the basic clinical characteristics and the management including a wide use of primary PCI, long-term mortality in women under forty after STEMI is significantly higher than in men.
authors.affiliation: Świętokrzyskie Cardiology Centre, Kielce, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Sadowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Janion-Sadowska
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
keywords: ST-segment elevation myocardial infarction; gender-related difference; mortality; myocardial infarction; young