title: Implications of myocardial reperfusion on survival in women versus men with acute myocardial infarction undergoing primary coronary intervention.
abstract: We evaluated the effects of myocardial perfusion after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) on gender-based mortality rates. Research has demonstrated a gender-specific response of cardiomyocytes to ischemia and a potential increase in myocardial salvage in women compared with men. Myocardial blush grade (MBG), an angiographic surrogate of myocardial perfusion, is an independent predictor of early and late survival after AMI. Whether the incidence and prognosis of myocardial perfusion differs according to gender among patients with AMI undergoing PCI is unknown. MBG and short- and long-term mortality were evaluated in 1,301 patients (male = 935; female = 366) with AMI randomized to primary angioplasty ± abciximab versus stent ± abciximab. Following PCI, >96% of patients achieved final Thrombolysis In Myocardial Infarction 3 flow, of which MBG 2/3 was present in 58.3% of women versus 51.1% of men (p = 0.02). Worse MBG was an independent predictor of mortality in women at 30 days (7.4% for MBG 0/1 vs 2.4% for MBG 2/3, p = 0.04) and at 1-year (11.0% for MBG 0/1 vs 3.4% for MBG 2/3, p = 0.01); however, MBG was not associated with differences in mortality for men. In conclusion, impaired myocardial perfusion following PCI for AMI, indicated by worse MBG, is an independent predictor of early and late mortality in women but not in men. These findings imply an enhanced survival benefit from restoring myocardial perfusion for women compared with men during primary angioplasty and may have clinical implications for interventional strategies in women.
authors.affiliation: Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Meller
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Costa
authors.forename: Morgan
authors.initials: M
authors.lastname: Soffler
authors.forename: Costantino O
authors.initials: CO
authors.lastname: Costantini
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D003326:Coronary Circulation / Q000502:physiology*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology