Primary angioplasty in women with ST-elevation myocardial infarction: in-hospital and long-term clinical results

Objectives: We evaluated in-hospital and long-term clinical results of female patients following primary angioplasty for ST-elevation myocardial infarction (STEMI), in comparison with male patients. Study design: We reviewed 2,644 patients (2,188 males, 456 females) who underwent primary angioplasty for STEMI between October 2003 and March 2008. Data on female patients concerning demographic and clinical characteristics, primary angioplasty results, in-hospital and 25-month followup results were compared with those of male patients. Results: Hypertension, diabetes mellitus, anemia, shock, and renal failure were more common in female patients, while smoking was more frequent in males (p<0.05). The mean age was higher in female patients (63.9 +/- 11.7 vs. 55.2 +/- 11.3, p<0.001). Females also presented with higher values of glucose, mean platelet volume, and platelet count, and lower hemoglobin and hematocrit values (p<0.05). The frequencies of multivessel disease and procedure failure were significantly higher, and pain-to-balloon time was significantly longer in females (p<0.05). Mortality associated with cardiovascular causes occurred in 148 patients (5.6%), being significantly higher in females (9.4% vs. 4.8%, p<0.001). In-hospital mortality, major cardiac events, stroke, cardiogenic shock, and major bleeding were more frequent in women (p<0.05). Long-term mortality rate was also significantly higher in females (10% vs. 4.5%, p<0.001). Multivariate analysis showed female gender as one of the independent predictors of mortality (odds ratio=1.75, 95% CI 1.02-2.99; p<0.04). Conclusion: Female patients with STEMI undergoing primary angioplasty have a higher risk profile and poorer in-hospital and follow-up clinical results. Therefore, female patients should be treated more aggressively.