Background: Delay from symptom onset to reperfusion by primary percutaneous coronary intervention (PCI) is longer in women and has been linked to increased mortality and worse clinical outcome. The mechanism underlying this association is still unclear. Purpose: We sought to investigate the impact of delay from symptom onset to hospital presentation on sex difference in TIMI flow grades and 30-day mortality after primary PCI for STEMI. Methods: The current study evaluated 2596 patients with STEMI who underwent primary PCI within 12 hours from symptom onset and had a stent implantation between 2010 and 2016 in the ISACS-TC registry (ClinicalTrials.gov, NCT01218776). Main outcomes measures were adjusted 30-day mortality rates and suboptimal post-PCI TIMI (Thrombolysis In Myocardial Infarction) flow (grades ≤2) estimated using inverse probability of treatment weighted (IPTW) models. Time from symptom onset to hospital presentation was classified as <2 hours, <6 hours, and <12 hours Results: Early reperfusion (<2 hours) was not associated with significant sex differences in the rates of mortality and final flow post-PCI TIMI flow (grades ≤2). Sex differences in outcomes differed if analyzing patients with≥2-hour delay. Mortality rates were 4.0% for women versus 2.1% for men with an OR of 1.94 (95% CI: 1.09 to 3.47) in patients with <6 hours delay, and 4.6% for women versus 2.3% for men with an OR of 2.02 (95% CI: 1.24 to 3.27) in patients with <12 hours delay. The odds of TIMI ≤2 in women versus men were 1.40 (95% CI: 0.85 to 2.31) in patients with <6 hours delay, and 1.49 (95% CI: 0.99 to 2.24) in patients with <12 hours delay. Conclusions: Longer delays to reperfusion are associated with sex differences in the rates of 30-day mortality and worse outcome in women. Women are more vulnerable to prolonged untreated ischemia. This effect appears not to be mediated by less successful reperfusion.
Sex difference in the impact of delay to reperfusion on coronary blood flow and outcomes in ST-segment elevation myocardial infarction / Cenko E, Manfrini O, Kedev S, Stankovic G, Vasiljevic Z, Van Der Schaar M, Yoon J, Vavlukis M, Kalpak O, Milicic D, Koller A, Badimon L, Bugiardini R. - In: EUROPEAN HEART JOURNAL. - ISSN 0195-668X. - ELETTRONICO. - 39:Issue suppl_1(2018), pp. 68-69. [10.1093/eurheartj/ehy564.P580]
Sex difference in the impact of delay to reperfusion on coronary blood flow and outcomes in ST-segment elevation myocardial infarction
Cenko E;Manfrini O;Bugiardini R
2018
Abstract
Background: Delay from symptom onset to reperfusion by primary percutaneous coronary intervention (PCI) is longer in women and has been linked to increased mortality and worse clinical outcome. The mechanism underlying this association is still unclear. Purpose: We sought to investigate the impact of delay from symptom onset to hospital presentation on sex difference in TIMI flow grades and 30-day mortality after primary PCI for STEMI. Methods: The current study evaluated 2596 patients with STEMI who underwent primary PCI within 12 hours from symptom onset and had a stent implantation between 2010 and 2016 in the ISACS-TC registry (ClinicalTrials.gov, NCT01218776). Main outcomes measures were adjusted 30-day mortality rates and suboptimal post-PCI TIMI (Thrombolysis In Myocardial Infarction) flow (grades ≤2) estimated using inverse probability of treatment weighted (IPTW) models. Time from symptom onset to hospital presentation was classified as <2 hours, <6 hours, and <12 hours Results: Early reperfusion (<2 hours) was not associated with significant sex differences in the rates of mortality and final flow post-PCI TIMI flow (grades ≤2). Sex differences in outcomes differed if analyzing patients with≥2-hour delay. Mortality rates were 4.0% for women versus 2.1% for men with an OR of 1.94 (95% CI: 1.09 to 3.47) in patients with <6 hours delay, and 4.6% for women versus 2.3% for men with an OR of 2.02 (95% CI: 1.24 to 3.27) in patients with <12 hours delay. The odds of TIMI ≤2 in women versus men were 1.40 (95% CI: 0.85 to 2.31) in patients with <6 hours delay, and 1.49 (95% CI: 0.99 to 2.24) in patients with <12 hours delay. Conclusions: Longer delays to reperfusion are associated with sex differences in the rates of 30-day mortality and worse outcome in women. Women are more vulnerable to prolonged untreated ischemia. This effect appears not to be mediated by less successful reperfusion.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
