title: Gender Differences in Left Ventricular Function Following Percutaneous Coronary Intervention for First Anterior Wall ST-Segment Elevation Myocardial Infarction.
abstract: Little is known regarding gender differences in left ventricular (LV) function after anterior wall ST-segment elevation myocardial infarction (STEMI), despite it being a major determinant of patients' morbidity and mortality. We therefore sought to investigate the impact of gender on LV function after primary percutaneous coronary intervention (PCI) for first anterior wall STEMI. Seven hundred eighty-nine consecutive patients (625 men) with first anterior STEMI were included in the analysis. All patients underwent an echocardiographic study within 48 hours of PCI. Women were older and more likely to have diabetes, hypertension, chronic renal failure, and a higher Killip score. Women had prolonged ischemic time, which was driven by prolonged symptom-to-presentation time (2.75 [interquartile range 1.5 to 4] vs 2 [interquartile range 1 to 3.5] hours, p = 0.005). A higher percentage of women had moderate or worse LV dysfunction (LV ejection fraction <40%; 61.6% vs 48%, p = 0.002). In a univariable analysis female gender was associated with moderate or worse LV function (p = 0.002). However, after accounting for variable baseline risk profiles between the 2 groups using multivariable and propensity score techniques, ischemic time >3.5 hours, leukocytosis, and pre-PCI Thrombolysis In Myocardial Infarction flow grade <2 were independent predictors of moderate or worse LV dysfunction, whereas female gender was not. Data on LV function recovery at 6 months, which were available for 45% of female and male patients with moderate or worse LV dysfunction early after PCI, showed no significant gender related difference in LV function recovery. In conclusion, women undergoing PCI for the first event of anterior STEMI demonstrate worse LV function than that of men, which might be partially attributed to delay in presentation. Hence greater efforts should be devoted to increasing women's awareness of cardiac symptoms during the prehospital course of STEMI.
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: adayawe@clalit.org.il.
authors.forename: Adaya
authors.initials: A
authors.lastname: Weissler-Snir
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sagie
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Leor
authors.initials: L
authors.lastname: Perl
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avital
authors.initials: A
authors.lastname: Porter
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.affiliation: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
mesh_terms: D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016277:Ventricular Function, Left / Q000502:physiology*