Prognostic impact of sex on clinical outcomes following emergent coronary angioplasty in acute myocardial infarction

BACKGROUND: Several studies have shown that women had greater risk for adverse clinical outcomes following coronary angioplasty. We aimed to assess the impact of sex on clinical results following emergent coronary angioplasty in acute myocardial infarction. METHODS: We used our database of patients treated for acute myocardial infarction using emergent coronary angioplasty between January 2001 and December 2003. Procedural and angiographic results and clinical outcomes up to 6 months were collected and adjudicated for major cardiac adverse events. The outcome of 352 patients with acute myocardial infarction (71 women, 281 men, no cardiogenic shock) undergoing emergent angioplasty was analyzed and compared according to sex. RESULTS: Acute myocardial infarction occurred at an older age among women who tended to suffer more from diabetes mellitus and hypertension. In addition, on average, women had smaller culprit vessel diameters than men. The immediate post-procedural data were notable for higher frequency of 'no/slow re-flow' angiographic phenomenon in women than in men (10.5 vs. 3.4%, P=0.04). In-hospital and 30-day mortality was three times higher in women than men (women vs. men: in hospital 7 vs. 2.1%, P=0.05; 30 days 9.9 vs. 3.2%, P=0.02). At 6 months, major adverse cardiac events rate was 28 vs. 15% among women vs. men (P=0.01). Multivariate analysis showed a strong trend towards increased mortality at 30 days among women undergoing acute myocardial infarction angioplasty although it was not significantly or independently related to increased mortality (odds ratio=3.1; confidence intervals=0.8-12.5; P=0.11). CONCLUSION: Our results indicate a trend towards higher early mortality among female patients sustaining acute myocardial infarction and treated using emergent percutaneous coronary intervention that was probably because of increased age and worse coronary flow restoration results among women compared with men.