Sex Differences in Mortality After Myocardial Infarction: The Role of Post Pci Flow and its Relation to Time Delay to Reperfusion

Introduction: Little is known regarding gender differences in coronary flow and 30 day mortality after primary PCI in STEMI, despite blood flow is a major determinant of patients’ prognosis. Hypothesis: We sought to investigate the impact of gender on TIMI flow grades, and related 30 day mortality after primary PCI for STEMI. Methods: Two thousand seven hundred twenty six patients (1999 men) with STEMI derived from the ISACSTC registry (NCT01218776) were included in the analysis. Pre PCI TIMI flow grades were categorized as high (2-3) or low (1-2). PCI success was defined as <25% residual insegment stenosis. Low post PCI TIMI flow grade was defined as ≤2. Multivariate logistic regression model was adjusted for important baseline and clinical covariates. The endpoint was 30 day mortality. Results: Women presented at an older age than men and were more likely to have diabetes and hypertension, but less likely to have a history of smoking. Median time from symptom onset to treatment was longer for women (316.5 vs 285 min; p=0.01). However, there were no differences between the sexes in median door to balloon time (45 vs 44 min p=0.42). Baseline TIMI flow grades were lower in women as compared with men (TIMI flow 2/3: 23.4% vs 28.9%, P=0.006). Women and men had similar angiographic PCI success (94.5% vs 96.1%, P=0.09). Nevertheless after the procedure men had higher rates of TIMI flow grade 3 compared with women (93.3% vs 89.3%, P= 0.001). Thirty day mortality was greater in women than men (6.5% vs 3.6%, P=0.001). Multivariate analysis linked time from symptom onset to treatment >2 hours, with post PCI TIMI flow grade ≤2 (OR 1.69, CI 1.112.57). The most significant variables associated with mortality were: age (OR 1.53, CI 1.261.87), diabetes (OR 1.65, CI 1.062.54), and post PCI TIMI flow grade≤2 (OR 7.92, CI 5.0812.33). Analysis showed that patient sex not to be an independent predictor of mortality (OR 1.10, CI 0.711.70). Conclusions: Time delay to reperfusion and low post PCI TIMI flow grade are significantly related to higher 30 day mortality in STEMI. Women have more delay to hospital presentation and less complete restoration of epicardial blood flow in culprit vessels after PCI,