Introduction: Previous works have shown that women hospitalized with STEMI have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary PCI. Purpose: We sought to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications and primary PCI in this excess of risk. Methods: From January 2010 to January 2016, a total of 8834 patients have been hospitalized and received medical treatment for STEMI in 41 hospitals, referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776). Logistic regression model was adjusted to covariates significantly different between groups in univariate analysis. The endpoint was 30-day mortality after STEMI. Results: There were 2657 women and 6177 men. Women were older than man, with a higher prevalence of risk factors and comorbidities. Fewer women than men presented within 2 hours from symptom onset (p<0.001). They presented more (p<0.001) Killip class ≥2 than men A significantly (p<0.001) lower proportion of women was treated with acute medications, secondary prevention therapies and primary PCI. Thirty day mortality was significantly higher for women than for men (11.6% versus 5.9%, p<0.001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% versus 3.3%, p<0.001). A significant interaction was found between sex and age. Women under 60 had higher early mortality risk than men of the same group (OR: 1.78, 95% CI: 1.04–3.05, p=0.03) after adjusting for age, comorbidities and treatment variables. Women aged 60–74 had the same risk of men (OR: 1.38, 95% CI: 0.95–1.99 p=0.08). The same results applied to women aged over 75 (OR: 1.06, 95% CI: 0.74–1.52, p=0.71). Conclusions: Younger age is associated with higher short term mortality rate in women with STEMI even after adjustment for medications, primary PCI and other coexisting comorbidities. This difference was no longer observed in older women
High rates of 30-day mortality in younger women presenting with STEMI: the ISACS Study
CENKO, EDINA;RICCI, BEATRICE;AMADUZZI, PETER LOUIS;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2017
Abstract
Introduction: Previous works have shown that women hospitalized with STEMI have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary PCI. Purpose: We sought to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications and primary PCI in this excess of risk. Methods: From January 2010 to January 2016, a total of 8834 patients have been hospitalized and received medical treatment for STEMI in 41 hospitals, referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776). Logistic regression model was adjusted to covariates significantly different between groups in univariate analysis. The endpoint was 30-day mortality after STEMI. Results: There were 2657 women and 6177 men. Women were older than man, with a higher prevalence of risk factors and comorbidities. Fewer women than men presented within 2 hours from symptom onset (p<0.001). They presented more (p<0.001) Killip class ≥2 than men A significantly (p<0.001) lower proportion of women was treated with acute medications, secondary prevention therapies and primary PCI. Thirty day mortality was significantly higher for women than for men (11.6% versus 5.9%, p<0.001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% versus 3.3%, p<0.001). A significant interaction was found between sex and age. Women under 60 had higher early mortality risk than men of the same group (OR: 1.78, 95% CI: 1.04–3.05, p=0.03) after adjusting for age, comorbidities and treatment variables. Women aged 60–74 had the same risk of men (OR: 1.38, 95% CI: 0.95–1.99 p=0.08). The same results applied to women aged over 75 (OR: 1.06, 95% CI: 0.74–1.52, p=0.71). Conclusions: Younger age is associated with higher short term mortality rate in women with STEMI even after adjustment for medications, primary PCI and other coexisting comorbidities. This difference was no longer observed in older womenI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
