Angioplastia primária na mulher: realidade nacional

Abstract

AimsAlthough mortality after primary percutaneous coronary intervention (PPCI) is higher in women than in men, there is disagreement as to whether gender is an independent risk factor for mortality in ST‐ elevation myocardial infarction (STEMI). Our aim was to assess how gender influenced short‐term prognosis in patients undergoing PPCI in the Portuguese Registry of Interventional Cardiology. MethodsOf 60 158 patients prospectively included in a large registry of contemporary PCI, from 2002 to 2012, we included 7544 patients with STEMI treated by PPCI, of whom 1856 (25%) were female. The effect of gender on in‐hospital mortality was assessed by multivariate logistic regression analysis with propensity score matching. ResultsWomen were older (68±14 vs. 61±13 years, p<0.001), with a higher prevalence of diabetes (30% vs. 21%, p<0.001) and hypertension (69% vs. 55%, p<0.001). Men were more frequently revascularized within six hours of symptom onset (71% vs. 63%, p<0.001). Cardiogenic shock was more frequent in women (7.1% vs. 5.7%, p=0.032). Female gender was associated with a worse short‐term prognosis, with 1.7 times higher risk of in‐hospital death (4.3% in women and 2.5% in men, 95% confidence interval (CI) 1.30‐2.27, p<0.001). After computed propensity score matching based on baseline clinical characteristics, in‐hospital mortality was similar between women and men (odds ratio 1.00, 95% CI 0.68‐1.48, p=1.00). ConclusionsIn the Registry, women with STEMI treated by PPCI had a greater risk‐factor burden, less timely access to treatment and a worse prognosis. However, after risk adjustment, female gender ceases to be an independent predictor of in‐hospital mortality.