Impact of gender on the long-term prognosis in acute STEMI patients undergoing primary percutaneous coronary intervention: analysis of 10-year all-comers registry
Authors: Cid Alvarez A.B , Juskova M , Tasende Rey P , Alvarez Alvarez B , Gonzalez Babarro E , Agra Bermejo R , Garcia Acuna J.M , Rigueiro Veloso P , Lopez Pais J , Sanmartin Pena J.C , Lopez Otero D , Trillo Nouche R , Gonzalez Juanatey J.R 
Published: November 2020

Abstract

Background
Published data about the impact of female gender on the long-term prognosis in patients with ST–elevation -myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) have been incoherent. Much of the registries show that the gender effect diminishes after control for age and comorbidities

Purpose
We sought to investigate the gender dependent impact on the long-term prognosis in STEMI patients undergoing PPCI.

Methods
This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. Our primary objective was to assess its impact of gender in all-cause mortality and major adverse cardiovascular events (MACE; death, recurrent MI, target vessel revascularization, heart failure) during follow-up.
Follow-up was performed through consultation of the electronic registries available in the autonomic community of Galicia (IANUS program); all medical evaluations and hospital registries were reviewed. Median follow-up was 3 years (interquartile range of 0.68–4.67 years).

Results
Of the 1965 patients with STEMI admitted for primary PCI, 464 (23,6%) were female. Women were on average 10 years older than men (71.5±13 vs. 61.5±12 yrs, p=0,000), with a higher prevalence of diabetes (25,2% vs 20,5% p=0,030) and hypertension (65,1% vs 44,5% p=0,000). With regard to system delays, the median time from first medical contact to PPCI were superior in women (116,3±83) than men (97,9±67) (p=0,000). Despite their older age women did not show differences in the extent of coronary disease (median SYNTAX score 13,60±8.0 vs. 14.33±8.7 in men, p=0,122). The GRACE score was higher for women (141.1±39 vs 120.8±35 p=0.07) and the incidence of cardiogenic shock at admission was 10.2% (7.1% in men, p=0,003). Furthermore, female patients received less guideline-directed medical therapy than men with less prescription of statins (93.6.5% vs 96.9%; p=0,003), and beta blockers (80.2% vs 85.1%; p=0.021), and having less radial access for PPCI (84.1% vs 90.1%; p=0.000).
The cumulative incidence of all-cause mortality was 19.4% vs 12.6% (p=0,000), the incidence of MACE was 31.9% vs 23.4% (p=0.000) for women and men respectively (Image 1). Multivariate analysis revealed that, after correction for baseline differences, gender remained and independent predictor for all-cause mortality (HR IC 95%: 1.922 (1.396–2.696) p=0.000)

Conclusions
In our “real-world” registry of patients with STEMI undergoing pPCI women had longer ischemic times, higher risk profiles, and differing interventional approaches compared with men and gender results an independent predictor for all-cause mortality. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
Image 1

Funding Acknowledgement
Type of funding source: None