Long-term outcomes in men and women with ST-segment elevation myocardial infarction and incomplete reperfusion after a primary percutaneous coronary intervention: a 2-year follow-up.

BACKGROUND

The failure of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) is more frequent than considered previously.

AIM

To evaluate sex-related differences in long-term outcomes in patients with STEMI and incomplete infarct-related artery reperfusion after a primary percutaneous coronary intervention.

PATIENTS AND METHODS

Of consecutive 42 752 patients with STEMI hospitalized between 2009 and 2011 in Poland, we analyzed a group of 766 (35%) women and 1453 (65%) men with less than thrombolysis in myocardial infarction (TIMI) flow grade 3 following a primary percutaneous coronary intervention.

RESULTS

In the 2-year follow-up, the mortality rate among women was significantly higher compared with men: 39.8 versus 30.9% (P=0.0009) in the TIMI 0 or 1 group, and 31.6 versus 20% (P<0.0001) in the TIMI 2 group. In women, the risk of rehospitalization because of heart failure was significantly higher irrespective of the final TIMI flow grade. In the multivariate analysis, female sex did not influence both in-hospital (odds ratio: 1.09; 95% confidence interval: 0.82-1.44; P=0.54) and long-term (hazard ratio: 1.14; 95% confidence interval: 0.97-1.34; P=0.11) mortality. Peripheral artery disease, anterior myocardial infarction, and previous stroke were associated with increased mortality only in men. Postprocedural TIMI flow grade 2 (vs. TIMI grade 0 or 1) was the strongest factor impacting mortality irrespective of sex.

CONCLUSION

Women with STEMI and postprocedural suboptimal epicardial blood flow have higher mortality than men and are at high risk of developing heart failure, with frequent in-patient visits. However, these differences may be attributed to the advanced age and worse clinical presentation of women compared with men.