Original title: Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent?: Gender difference in STMI stratified on age Reference: Amber M Otten et, al.European Heart Journal Acute Cardiovascular Care January 31:1-8
Numerous publications have shown that women have worse outcomes than men in chronic ischemic heart disease but their evolution in the context of ST segment elevation acute myocardial infarction, (STEMI), has not been fully studied.
6,746 patients admitted with STEMI were analyzed between 1998 and 2008, dividing them into four groups: women under 65 years (n = 708), men younger than 65 years (n = 3,006), women older than 65 years (n = 1,045) and men older than 65 years (n = 1,985).
Women had more time from the onset of symptoms to hospital admission as opposed to door-to-balloon time that was equal in both sexes. At initial angiography less obstructive disease was found, a higher TIMI 3 flow and a reduced release of CK in women younger than 65 years versus men in the same age group. In the larger group of over 65 years there was no difference between the sexes in multi-vessel disease and TIMI flow 3. The result after angioplasty in terms of TIMI and Blush was similar in both sexes.
Overall mortality at thirty days and one year was greater in women. In the group under 65 years women had a higher mortality rate at both thirty days and one year. For those over 65 years the mortality rate was higher only after thirty days.
Conclusion:
The difference in mortality between men and women admitted with an acute ST segment elevation was age dependent. Young women had less frequent coronary obstruction and TIMI 3 flow before angioplasty, suggesting a lower risk, yet their prognosis was worse compared with men of the same age.
Comment:
The delay in consulting a hospital from the onset of symptoms may explain the impact on mortality in women.
Courtesy Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation.
Dr. Carlos Fava para SOLACI.ORG