P6077Gender-related differences in short and long-term all-cause mortality in unselected patients undergoing primary percutaneous coronary intervention

Abstract

Background: Primary percutaneous coronary intervention (PCI) improved prognosis of patients with acute ST-elevation myocardial infarction (STEMI). However, studies have shown sex-based disparities in outcomes after primary PCI. Purpose(s): This study sought to investigate the influence of gender on short and long-term mortality in unselected STEMI patients treated with primary PCI. Method(s): Data of all consecutive STEMI patients admitted for primary PCI between 8/2009 and 12/2012, enrolled in a prospective registry of a high volume tertiary centre, were analyzed. In-hospital bleeding was assessed using Bleeding Academic Research Consortium (BARC) criteria. The primary outcomes were 30-day, 1-year, and 4-year all cause mortality. Result(s): Of the 3034 consecutive STEMI patients underwent emergency coronary angiography, 2715 were treated with primary PCI, of whom 807 (29.7%) were female. In comparison to men, women were significantly older, with higher prevalence of diabetes, hypertension and hypercholesterolemia. Women also showed higher incidence of Killip class II-IV, renal insufficiency and anaemia at admission, and higher rates of in-hospital BARC type >=2 bleeding (11.9% vs. 3.9%, p<0.001). Compared with man, women had significantly higher rates of 30-day (9.4% vs. 5.2%; p<0.001), 1-year (16.0% vs. 9.8%; p<0.001) and 4-year (21.6% vs. 15.7%; p<0.001) all-cause mortality. Kaplan-Meier curves for 4-year survival are shown in Figure. However, after adjusting baseline differences using multivariate analysis, female sex was not an independent predictor of mortality at 30-days (HR 1.08, 95% CI 0.74-1.56; p=0.692) as well as at 1-year (HR 1.05, 95% CI 0.80-1.38; p=0.704) and at 4-years (HR 0.87, 95% CI 0.70-1.08; p=0.214) follow up. Conclusion(s): This study found that women treated with primary PCI had higher risk profile, more co-morbidity and were at increased risk of bleeding as compared to men. However, female gender was not an independent predictor of short and long-term mortality.