Early and late mortality in emergency PCI for STEMI was similar in women and men, despite longer door-to-balloon (D2B) times in women, according to a study presented at the annual American College of Cardiology (ACC) conference in Atlanta last month.
Previous reports have suggested that women have less favorable outcomes following PCI for STEMI than men, according to lead author Elizabeth Grey, MD, from the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital in Minneapolis. She and her colleagues sought to assess early and late mortality for women versus men after emergency PCI for STEMI at Abbott.
The researchers reviewed the records of consecutive STEMI patients treated with emergency PCI or CABG as part of our Level 1 acute STEMI program. All patients were treated at Abbott, a tertiary cardiac center with referral relationships with 31 referring hospitals in Minnesota and Wisconsin, which instituted the Level 1 MI Program in 2003. Patients received half-dose thrombolytics if transfer for PCI was delayed, or if more than 60 miles from the center. Patients were followed after discharge by clinic visits and telephone calls. Researchers performed age-adjusted analyses with logistic regression.
For patients with STEMI, Grey and colleagues found that early and late mortality were similar for men and women after adjusting for age, despite the fact that a higher percentage of women present in cardiogenic shock (CS).
For those patients without CS, in-hospital mortality rate was 2.4 percent for women and 1.2 percent for men. Female patients without CS had a higher percentage of 30-day and one-year mortality rates compared with men without CS: 2.8 versus 1.6 percent and 4.5 versus 2.7 percent, respectively.
For those patients with CS, in-hospital mortality rate was 32.9 percent for women and 28.1 percent for men. Female patients with CS had a higher percentage of 30-day and one-year mortality rates compared with men with CS: 34.1 versus 29.3 percent and 36.6 versus 32.2 percent, respectively.
D2B times are slightly different in women compared to men, Grey reported. When examined by age quartile, there is a “more striking difference” in the younger age group, despite the advent of standard STEMI treatment protocols, the researchers found.
They also found that women aged 63-74 (99 patients) actually had a shorter D2B time than men in this age group (103 patients).
Grey and her colleagues said more investigation is needed to determine whether this is patient-driven or due to physician bias.
However, they said that their findings support a community strategy of catheter-based rapid reperfusion for all patients who suffer an acute STEMI.