title: Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: insights from the DESERT cooperation.
abstract: BACKGROUND
  Several studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug-eluting stents (DES). Therefore, the aim of this study was to investigate sex-related differences in clinical outcome in patients with STEMI treated with primary angioplasty with Bare-Metal Stent (BMS) or DES.
  
  
  METHODS
  Our population is represented by 6298 STEMI patients undergoing primary angioplasty and stent implantation included in the DESERT database. Follow-up data were collected from 3 to 6 years after primary angioplasty.
  
  
  RESULTS
  Female gender was observed in 1466 (23.2%) out of 6298 STEMI patients. Women were older (65.3 ± 12.4 vs 59.3 ± 11.4 years, p < 0.001), with higher prevalence of diabetes (18.6% vs 14.5%, p < 0.001), hypertension (52.4% vs 41.4%, p < 0.001), slightly longer ischemia time (272 ± 247 vs 258 ± 220 min, p = 0.06). No difference was observed in terms of angiographic and procedural characteristics. Follow-up data were available at a mean of 1201 ± 441 days. At long-term follow-up female gender was associated with a significantly higher rate of death (11.7% vs 8.5%, HR [95% CI] = 1.45 [1.18-1.78], p < 0.001), while no difference was observed in terms of reinfarction (HR [95% CI] = 1.14 [0.89-1.45], p = 0.3), ST (HR [95% CI] = 1.12 [0.85-1.48], p = 0.4), with similar temporal distribution (acute, subacute, late and very late) between male and female patients, and no difference in TVR (HR [95% CI] = 1.11 [0.95-1.3], p = 0.2, p = 0.2). These results were confirmed in both patients receiving BMS or DES. The impact of female gender on mortality disappeared after correction for baseline confounding factors (HR [95% CI] = 0.88 [0.71-1.09], p = 0.25).
  
  
  CONCLUSIONS
  This study shows that in patients with STEMI treated by primary angioplasty, female gender is associated with higher mortality rate in comparison with men, and this is mainly due to their higher clinical and angiographic risk profiles. In fact, female sex did not emerge as an independent predictor of mortality.
authors: Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors: Giuseppe
authors: G
authors: De Luca
authors: Monica
authors: M
authors: Verdoia
authors: Maurits T
authors: MT
authors: Dirksen
authors: Christian
authors: C
authors: Spaulding
authors: Henning
authors: H
authors: Kelbæk
authors: Martin
authors: M
authors: Schalij
authors: Leif
authors: L
authors: Thuesen
authors: Bas van der
authors: Bv
authors: Hoeven
authors: Marteen A
authors: MA
authors: Vink
authors: Christoph
authors: C
authors: Kaiser
authors: Carmine
authors: C
authors: Musto
authors: Tania
authors: T
authors: Chechi
authors: Gaia
authors: G
authors: Spaziani
authors: Luis Salvador
authors: LS
authors: Diaz de la Llera
authors: Vincenzo
authors: V
authors: Pasceri
authors: Emilio
authors: E
authors: Di Lorenzo
authors: Roberto
authors: R
authors: Violini
authors: Harry
authors: H
authors: Suryapranata
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D016208:Databases, Factual; D048909:Diabetes Complications / Q000628:therapy; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D007511:Ischemia; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010975:Platelet Aggregation Inhibitors
keywords: Drug-eluting stent; Female gender; Primary angioplasty