Primary angioplasty in women: Data from the Portuguese Registry of Interventional Cardiology.

Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology

PubMedID: 24998096

Calé R, de Sousa L, Pereira H, Costa M, de Sousa Almeida M, em nome dos Investigadores do Registo Nacional de Cardiologia de Intervenção. Primary angioplasty in women: Data from the Portuguese Registry of Interventional Cardiology. Rev Port Cardiol. 2014;.
AIMS
Although mortality after primary percutaneous coronary intervention (PPCI) is higher in women than in men, there is disagreement as to whether gender is an independent risk factor for mortality in ST- elevation myocardial infarction (STEMI). Our aim was to assess how gender influenced short-term prognosis in patients undergoing PPCI in the Portuguese Registry of Interventional Cardiology.

METHODS
Of 60 158 patients prospectively included in a large registry of contemporary PCI, from 2002 to 2012, we included 7544 patients with STEMI treated by PPCI, of whom 1856 (25%) were female. The effect of gender on in-hospital mortality was assessed by multivariate logistic regression analysis with propensity score matching.

RESULTS
Women were older (68±14 vs. 61±13 years, p<0.001), with a higher prevalence of diabetes (30% vs. 21%, p<0.001) and hypertension (69% vs. 55%, p<0.001). Men were more frequently revascularized within six hours of symptom onset (71% vs. 63%, p<0.001). Cardiogenic shock was more frequent in women (7.1% vs. 5.7%, p=0.032). Female gender was associated with a worse short-term prognosis, with 1.7 times higher risk of in-hospital death (4.3% in women and 2.5% in men, 95% confidence interval (CI) 1.30-2.27, p<0.001). After computed propensity score matching based on baseline clinical characteristics, in-hospital mortality was similar between women and men (odds ratio 1.00, 95% CI 0.68-1.48, p=1.00).

CONCLUSIONS
In the Registry, women with STEMI treated by PPCI had a greater risk-factor burden, less timely access to treatment and a worse prognosis. However, after risk adjustment, female gender ceases to be an independent predictor of in-hospital mortality.