title: Acute myocardial infarction due to left main coronary artery disease in men and women: does ST-segment elevation matter?
abstract: BACKGROUND
  Gender-specific issues regarding ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) due to unprotected left main coronary artery (ULMCA) disease were not sufficiently studied. We assessed the value of STEMI/NSTEMI initial classification on the management of men and women with acute MI due to critical stenosis or occlusion of the ULMCA.
  
  
  METHODS
  The study group consisted of 643 consecutive patients with acute MI with the ULMCA as the infarct-related artery. Data derive from an ongoing, nationwide, multicenter, prospective, observational registry.
  
  
  RESULTS
  Isolated ULMCA disease was more frequent in women and multivessel disease was more frequent in men in the NSTEMI group. The incidence of cardiogenic shock or pulmonary edema and cardiac arrest was higher in the STEMI group. Totally occluded ULMCA was more frequent in the STEMI group. Although the majority of patients underwent percutaneous coronary intervention (PCI), it was less frequently used in NSTEMI women and NSTEMI men. Although in-hospital and long-term mortality rates were higher in the STEMI group, there were no gender-related differences within groups. The initial ST-segment elevation was an independent predictor of in-hospital (OR = 2.37, 95% CI: 1.14-4.91, p = 0.02) and 12-month (OR = 1.52, 95% CI: 1.01-2.27, p = 0.045) mortality.
  
  
  CONCLUSIONS
  There were no gender-related differences in the management within the STEMI or NSTEMI group. Although acute myocardial infarction due to ULMCA disease is associated with high mortality in both genders, STEMI was a negative prognostic factor of in-hospital and 12-month mortality. Despite poor baseline characteristics and clinical presentation in women, female gender itself did not influence mortality.
authors.affiliation: Department of Interventional Cardiology, Świętokrzyskie Cardiology Center, Kielce, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Sadowski
authors.affiliation: Department of Interventional Cardiology, Świętokrzyskie Cardiology Center, Kielce, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Gutkowski
authors.affiliation: Department of Interventional Cardiology, Świętokrzyskie Cardiology Center, Kielce, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Raczyński
authors.affiliation: Intensive Cardiac Care Unit, Świętokrzyskie Cardiology Center, KIelce, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Janion-Sadowska
authors.affiliation: 3 Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.affiliation: 3 Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
keywords: ST-segment; gender; left main; myocardial infarction; women