title: The impact of gender on long-term mortality in patients with multivessel disease after primary percutaneous coronary intervention.
abstract: BACKGROUND
  Gender and complete revascularisation are known to affect mortality. The objective of this study was to analyse a gender difference in mortality with respect to complete revascularisation for multivessel disease after primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) patients.
  
  
  METHODS
  In a prospective consecutive cohort of 1472 patients presenting with STEMI for PPCI, between January 2006 and January 2010, 832 patients with multivessel disease were analysed. The primary outcome was long-term mortality.
  
  
  RESULTS
  Median follow-up was 3.3 ± 1.2 years. Complete revascularisation was performed less in females than in males (30 vs. 38 %; p = 0.04). At PPCI, women (27 %, n = 221) were ± 10 years older (p = 0.001), had more hypertension, renal failure and symptoms of heart failure (all p < 0.01). Cumulative long-term mortality with incomplete revascularisation was higher in females (F: 30 vs. M: 15 %, p = 0.01). After adjustment for baseline characteristics, complete revascularisation (0.84; 95 % CI 0.54-1.32) and gender (1.11; 95 % CI 0.73-1.69) lost significance. Also the gender-by-complete revascularisation interaction was not significant at long term. In women, age under 60 years independently predicted higher mortality (HR 10.09; 95 % CI 3.08-33.08; p < 0.001).
  
  
  CONCLUSIONS
  In STEMI patients with multivessel disease at PPCI, women under the age of 60 years had higher mortality, but in women older than 60 years comorbidity impacted the outcome of revascularisation strategy in the long term.
authors.affiliation: Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands. sh.imami@hagaziekenhuis.nl.
authors.forename: S
authors.initials: S
authors.lastname: Ghauharali-Imami
authors.affiliation: Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Bax
authors.affiliation: Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Haasdijk
authors.affiliation: Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Schotborgh
authors.affiliation: Medical Centre Haaglanden, The Hague, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Oemrawsingh
authors.affiliation: Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bech
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Domburg
authors.affiliation: Erasmus MC, Rotterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
keywords: Complete revascularisation; Gender; Mortality; ST-elevation myocardial infarction