When treating ST-segment elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI), does the patient’s sex have a role in their outcomes? According to a study published online Aug. 12 in Catheterization and Cardiovascular Outcomes, the answer is yes.
The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial sought to determine differences in long- and short-term outcomes between males and females undergoing PCI for STEMI.
Jennifer Yu, MBBS, lead author from the Icahn School of Medicine at Mount Sinai in New York and colleagues looked at outcomes for 3,602 patients at 30 days, one year and three years post PCI. Females comprised 23.4 percent of patients enrolled.
Symptom onset to balloon time was longer in women than in men, 237.5 minutes against 218 minutes. Yu et al noted that this was corollary to how much longer it took for women to present to the hospital than men at the onset of symptoms, which was, on average, a difference of 10 minutes.
Women in the study were more likely to be treated with medical management alone versus men and fewer women were treated with primary PCI than men proportionally.
More women were also given warfarin and diuretics, while more men were given statins and beta-blockers for out of hospital treatment.
They found that at all time points, women had higher incidents of death, major adverse cardiac events, major bleeding, and target vessel revascularization than men, in spite of the larger male cohort. One of the few disparities that reduced over time was a composite of death or reinfarction, while at the 30-day mark, the difference was significant between men and women. By three years, rates were similar.
Women had a doubled risk of bleeding over men at 30 days and up to three years following PCI. Even after adjusting for warfarin use and radial access, Yu et al found that women still had higher risks for bleeding. With warfarin in the equation, bleeding occurred in 5.9 percent of women compared to 3.4 percent of men. Without warfarin, three-year rates of major bleeding jumped to 13.4 percent in women versus 7.0 percent in men.
Yu et al suggested that the differences may be due to the fact that the female population of the study was in poorer health at baseline. These findings, they wrote, should generate discussion and further improvements to PCI and STEMI clinical practice.