Do gender differences in primary PCI mortality represent a different use of guideline adherent therapy?

Abstract

Purpose: Gender differences in outcome of patients presenting with acute ST-elevation myocardial infarction (STEMI) are known. There is some uncertainty whether this is only attributable to different baseline characteristics or additional factors. Therefore we compared indicators of guideline adherent therapy in a large cohort of consecutive STEMI patients according to gender. Methods: We combined the databases of two German myocardial infarction network registries with a total of n = 1104 consecutive patients admitted for primary percutaneous coronary intervention (PCI). Databases contain information on baseline characteristics, time delays to reperfusion, reperfusion therapy, secondary prophylaxis and long term outcome. Both networks aim at reperfusion therapy with primary PCI for all regional STEMI patients. Network A (n = 603 patients) is located in the Northeast and network B (n = 501 patients) in the Southwest of Germany. Patients were included from 2001-2003 (network A) and 2005-2007 (network B). Results: Approximately 25% of patients were female. Their mean age at presentation was eight years older than in male patients (69 vs 61 years) and they had significantly more often diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%). Presence of cardiogenic shock was comparable (10% vs 9%) in both genders. Mean prehospital delay was insignificantly longer in female patients (229 vs 210 min) as was the in hospital delay until start of catherization (35 vs 31 min). Emergency medical services (EMS) escorted transfer with announcement to the interventional facility was comparable in both genders (60% vs 59%). Procedural success (95% vs 97%) and mean number of stents (1.41 vs. 1.45) was also comparable. Use of GP 2b 3a blockers, however, was less frequent in females (75% vs 89%). At discharge prescription of anticoagulants was numerically higher in females (12% vs 10%) with lesser use of antiplatelets, whereas prescription of beta blockers and lipid lowering drugs was significantly lower in females (84% vs 90% and 71% vs 84%). These differences were more pronounced in network A. Differences in secondary prophylaxis persisted at 12 month (data only available for network B). Hospital mortality was significantly higher infemales (10% vs 4%) as was 6 month mortality (14% vs 7%). Conclusions: Higher mortality in females after primary PCI in an unselected STEMI population was accompanied by significant differences in baseline characteristics and secondary prophylaxis whereas time delays before reperfusion and reperfusion success were comparable.