Outcomes in woman with stemi

Abstract

The acute coronary syndrome with ST segment elevation (STEMI) has been widely discussed in the literature, but there are still many discrepancies between the different observations. We tried to make a contribution by evaluating the differences between the two sexes on a series of 651 patients, paying particular attention to the reperfusion strategy and its results, LV dysfunction, management delays and hospital mortality. Our study is a retrospective study of 651 patients received consecutively for STEMI, reperfused by thrombolysis with angiographic control or having undergone primary angioplasty. The 651 patients were 13% of women and 87% of men (sex ratio 7/1). The average age was 58 for women and 56 for men ( P = 0.16). Apart from tobacco, the prevalence of all cardiovascular risk factors was significantly higher in women. The women presented in consultation 40 min later than men in an average delay of 290 minutes ( P < 0.05). Thrombolysis was performed in 44% of women vs. 53% of men ( P = 0.15), the primary angioplasty was performed in 56% and 46%, respectively ( P = 0.15). The restoration of a TIMI3 flow at angiography was observed in 78% of thrombolysate men versus 75% in women ( P = 0.47). This rate after primary angioplasty was significantly lower in women 65% compared with men 85% ( P = 0.002) regardless of the reperfusion time, this is valid for the regression of the elevation of the ST segment (62% vs. 41%, P < 0.001). Coronary lesions are comparable in both sexes. There was more shock in women 10% vs. 5% ( P = 0.03) and more LV dysfunction 38% vs. 26% ( P = 0.04). Finally, hospital deaths of cardiac origin are significantly higher in women 10% against 4% ( P = 0.02), as well as complications ( P = 0.01). Despite of a management that appears to be similar in both sexes, there is more LV dysfunction, hemorrhagic complications and mortality in women, we also found a higher rate of NORFLOW in woman treated with primary angioplaty.