Coronary artery disease
Comparison of Mortality Rates in Women Versus Men Presenting With ST-Segment Elevation Myocardial Infarction

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Women who present with coronary artery disease have different characteristics, undergo different treatment, and have a different prognosis than men. The increasing use of coronary stenting has improved the outcome of percutaneous coronary intervention (PCI). However, little is known about the outcomes for men versus women after PCI, especially for those presenting with a diagnosis of acute coronary syndrome. Thus, we compared the baseline features, management, and long-term outlook of men versus women undergoing PCI. All consecutive patients who had undergone PCI with stents at our center from July 1, 2002 to June 30, 2004 were identified retrospectively. The primary end point was the long-term rate of major adverse cardiac events (i.e., death, infarction, and repeat revascularization). The secondary end points were the individual components of the major adverse cardiac events and stent thrombosis. A total of 833 patients were included, 210 women (25.2%) and 623 men (75.8%). The women were significantly older (70.9 vs 63 years, p <0.001) and more often had diabetes mellitus (36.2% vs 21.0%, p <0.001) and hypertension (82.3% vs 73.7%, p = 0.006). The number of drug-eluting stents and the length were significantly lower in the female patients. The incidence of major adverse cardiac events after a median follow-up of 60 months was similar for both women and men (38.8% vs 46.4%, p = 0.075), with a trend toward greater mortality rate for women (21.2% vs 15.4%, p = 0.090). All other end points occurred with similar frequencies. Only in the subgroup of ST-segment elevation myocardial infarction were the rates of death significantly greater for the women than for the men (20.0% vs 8.1%; p = 0.029). In conclusion, very long-term follow-up of women undergoing PCI with coronary artery stenting resulted in similar rates of cardiac event compared to those of men, but greater care should be given to women presenting with ST-segment elevation myocardial infarction. Also, despite their greater baseline risk profile, women were significantly less likely to have received effective treatment, the use of including drug-eluting stents.

Section snippets

Methods

The present retrospective study included all consecutive patients who had undergone percutaneous transluminal coronary angioplasty at our center from July 2002 to December 2004. These patients were divided into 2 cohorts according to their gender. All patients had provided written informed consent for the procedure, and ethical approval was waived, given the retrospective, observational design.

All patients had been pretreated with aspirin 100 mg/day and clopidogrel 75 mg/day or ticlopidine 250

Results

A total of 833 patients were selected, 210 women and 623 men. The clinical, angiographic, and procedural characteristics are summarized in Table 1, Table 2. Although the women were older and had greater rates of the most important cardiovascular risk factors, such as diabetes mellitus and hypertension, the men had more frequently reported a previous surgical or percutaneous revascularization. Also, the admission diagnosis showed significant differences, with greater rates of unstable coronary

Discussion

The most important findings of our long-term observational study were first that the men were more likely to report a previous cardiac event and women presented with greater rates of cardiovascular risk factors. Second, the long-term outcomes between the female and male patients were not statistically significant. Finally, great attention should be given to women presenting with a diagnosis of STEMI.

In our registry, the women had more risk factors than did the men. In contrast, the men had had

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Drs. D'Ascenzo and Gonella contributed equally to this report.

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