title: Sex-related differences in patients with ST-elevation myocardial infarction undergoing primary PCI: A long-term mortality study.
abstract: OBJECTIVE
  To assess sex differences in clinical presentation, in-hospital and long-term outcome in ST-elevated myocardial infarction (STEMI) patients undergoing primary PCI (PPCI).
  
  
  BACKGROUND
  Several studies have shown higher rates of mortality in women. These differences are not always confirmed after adjusting for confounding variables.
  
  
  METHODS
  From January 2007 to December 2011, 325 consecutive patients (23.1% females and 76.9% males) were prospectively treated and retrospectively analyzed. Primary outcome was in-hospital and long-term mortality.
  
  
  RESULTS
  Women were older (71.8±11.7 vs. 62.5±12.6years; p<0.0001), presented more renal failure (45.3% vs. 20.8%; p<0.0001) and severe haemodynamic impairment (9.3% vs. 3.6%; p=0.04). In-hospital overall mortality (14.7% vs. 4.8%; p=0.003) and cardiac death (12% vs. 2%; p=0.002) were significantly higher in women. The multivariate analysis identified age (OR 1.07; 95% CI: 1.01-1.13), resuscitated cardiac arrest (CCA) and cardiogenic shock (CS) (OR 15.31; 95% CI: 4.30-61.75), renal failure (OR 0.20; 95% CI: 0.06-0.68), but not sex (OR 1.49; 95% CI: 0.53-4.22) as independent prognostic factors of in-hospital mortality. During a median follow-up of 46.5months (IQR range 32.7-63.1months), long-term overall mortality (24.2% vs. 11.0%; p=0.007) and cardiac death (4.8% vs. 1.7%; p=0.02) were significantly higher in women. The multivariate analysis identified age (HR 1.06; 95% CI: 1.02-1.11), previous AMI (HR 3.9; 95% CI: 1.63-9.35), renal failure (HR 5.21; 95% CI: 2.12-12.85), technical success (HR 0.35; 95% CI: 0.14-0.84) but not sex (HR 0.90; 95% CI: 0.42-1.94) as independent prognostic factors of long-term mortality.
  
  
  CONCLUSIONS
  Worse clinical presentation rather than sex may explain the excess of mortality in women with STEMI undergoing PPCI.
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy. Electronic address: biava.lorenza@gmail.com.
authors.forename: Lorenza Michela
authors.initials: LM
authors.lastname: Biava
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scacciatella
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Calcagnile
authors.affiliation: Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, P.zza Polonia, 94-10126 Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Dalmasso
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Anna Laura
authors.initials: AL
authors.lastname: Fanelli
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Meynet
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pennone
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: Dipartimento Cardiovascolare e Toracico, Azienda Ospedaliera Città della Salute e della Scienza di Torino,c.so Bramante 88-10126, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D012307:Risk Factors; D012727:Sex Characteristics; D012770:Shock, Cardiogenic / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute myocardial infarction; Angioplasty; Gender