Letter to the Editor
Impact of gender differences on long-term outcomes after successful percutaneous coronary intervention in patients with acute myocardial infarction

https://doi.org/10.1016/j.ijcard.2010.02.028Get rights and content

Abstract

Many observational and randomized studies have suggested that women have a higher short-term mortality after acute myocardial infarction (AMI) following primary percutaneous coronary intervention (PCI). However, little is known about the effect of gender differences on short- and long-term outcomes in the drug-eluting stent (DES) era. To evaluate the clinical outcomes of women who have undergone PCI with DES, we analyzed 3298 consecutive eligible patients using the Korea Acute Myocardial Infarction Registry (KAMIR). No differences in primary PCI success rates were found between women and men. On univariate analysis, women showed worse outcomes than men for one-month major adverse cardiac event (MACE) (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.81–2.92) and 12-month MACE (OR, 1.64; 95% CI, 1.36–1.97). On multivariable analysis, older age (OR, 1.03; 95% CI, 1.02–1.05), dyslipidemia (OR, 2.28; 95% CI, 1.16–4.49), smoking (OR, 1.54; 95% CI, 1.07–2.21) and Killip class (OR, 3.63; 95% CI, 2.76–4.91), but not gender, were associated with one-month MACE in this national registry. In 12-month MACE, old age, ischemic heart disease history, diabetes, dyslipidemia, and Killip class were independent predictors of patients undergoing primary PCI with DES. Older age and additional comorbidities, but not gender, are likely to explain the deteriorating short- and long-term outcomes in the DES era.

Introduction

Many studies on gender difference after acute myocardial infarction (AMI) have demonstrated that women have a higher mortality than men and usually receive less aggressive treatment [1], [2]. Other colleges have already shown significant gender differences in the short-term outcomes after AMI in Koreans [2]. Compared with 1990s, primary PCI with DES was more commonly performed in Korea. However, short- and long-term outcomes for women after primary PCI in AMI with DES have not been fully investigated. We investigated the impact of gender on success and outcome after primary PCI with AMI in DES era.

Section snippets

Methods and results

Between November 2005 and February 2008, we analyzed 3298 eligible patients (2416 male, 882 female; age = 61.9 ± 12.5 years) who had completed 12 months of follow-up data in the KAMIR. The diagnosis of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) was conducted using the criteria of clinical presentation, electrocardiogram findings and cardiac enzyme studies. Primary PCI and early invasive PCI were defined in our previous study [2]. The treatment

Discussion

Several recent studies on the gender difference in mortality after AMI have consistently demonstrated that women have a higher mortality than men [1], [2]. But some studies have indicated that there is no difference [3], and other studies have shown a lower rate of mortality for women compared with men [4], [5]. These compelling data suggest strong rationale for focusing on the study of gender difference in the outcome of AMI. Almost all previous supporting studies on gender differences were

Acknowledgements

This study was carried out with the support of the Korean Circulation Society (KCS) in the memorandum of the 50th Anniversary of the KCS. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [6].

References (6)

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