title: Worse outcome in women with STEMI: a systematic review of prognostic studies.
abstract: BACKGROUND
  Treatment of ST elevation myocardial infarction (STEMI) has improved enormously since the introduction of primary percutaneous coronary intervention (pPCI). It remains unclear whether differences in survival between women and men treated with pPCI exist and whether these potential differences can be explained by gender or by differences in baseline- or procedural characteristics. Therefore we systematically reviewed the available evidence.
  
  
  METHODS
  On 10 May 2013 PubMed, Embase and Cochrane were searched for studies comprising original data on STEMI patients treated with pPCI. A separate gender analysis including > 100 women was a requirement. Data were extracted and pooled whenever possible.
  
  
  RESULTS
  21 studies were included from 2001 to 2013 comprising 47.439 men and 16.927 women. Women were older, had more diabetes (women 24%, men 15%) and hypertension (women 58%, men 45%), and were less current smokers (women 30%, men 54%). The procedural characteristics were comparable except for a longer symptom-to-balloon time (women 266 min, men 240 min) and less use of GP IIb/IIIa inhibitors in women (women 51%, men 57%). Crude short- and long-term mortality was higher in women. Although we could not pool adjusted mortality proportions due to heterogeneity, generally the difference in mortality disappeared after adjustment for baseline- and procedural characteristics.
  
  
  CONCLUSIONS
  Mortality is higher in women with STEMI and can be explained by their unfavourable risk profile and longer symptom-to-balloon time.
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Manon G
authors.initials: MG
authors.lastname: van der Meer
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Nathoe
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Yolande
authors.initials: Y
authors.lastname: Appelman
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors
keywords: Gender; ST elevation myocardial infarction; primary PCI