title: Short and long-term mortality in women and men undergoing primary angioplasty: A comprehensive meta-analysis.
abstract: BACKGROUND
  Women with acute myocardial infarction are treated less aggressively than men and have a higher mortality. It is possible that these sex-related differences in outcome are a result of differences in baseline risk and management.
  
  
  RESULTS
  We undertook a meta-analysis to study the differences in mortality among women and men with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (P-PCI). Studies reporting sex-specific crude mortality rates and/or adjusted effect estimates in STEMI patients undergoing P-PCI were identified. Among 48 studies, involving 103,895 patients, (26,556 women and 77,337 men), the crude in-hospital [pooled relative risk (RR): 1.94, 95% confidence interval (CI): 1.74-2.16, p<0.001; 23 studies (n=43,872)], 30-day [RR: 1.76, 95% CI: 1.50-2.07, p<0.001; 20 studies (n=43,279)], and long-term [RR: 1.60, 95% CI: 1.46-1.76, p<0.001; 26 studies (n=51,656)] mortality was significantly higher in women compared to men. When meta-analysis using adjusted effect estimates from individual studies was performed, in-hospital [RR: 1.31, 95% CI: 1.08-1.65, p=0.007; 14 studies (n=33,380)] and 30-day mortality [RR: 1.19, 95% CI: 1.01-1.39, p=0.03; 14 studies (n=28,564)] remained significant while long-term mortality [RR: 1.01, 95% CI: 0.93-1.11, p=0.75; 20 studies (n=52,492)] was no longer different between women and men.
  
  
  CONCLUSIONS
  Sex-based differences exist in short and long-term mortality among patients with STEMI undergoing P-PCI. However, these differences were markedly attenuated following adjustment for clinical differences and/or hospital course. Despite adjustment, short-term mortality remains higher in women than men, while long-term mortality was no longer significantly different.
authors.affiliation: Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Dipen
authors.initials: D
authors.lastname: Patel
authors.affiliation: Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Mount Sinai St. Luke's Hospital, New York, NY, USA.
authors.forename: Vrinda
authors.initials: V
authors.lastname: Trivedi
authors.affiliation: Mount Sinai St. Luke's Hospital, New York, NY, USA. Electronic address: JTamis@chpnet.org.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tamis-Holland
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D012727:Sex Characteristics; D016896:Treatment Outcome
keywords: Gender; Mortality; Primary PCI; STEMI; Sex difference