Association of Sex With Outcomes in Primary PCI for STEMI
Background Historically, women with ST elevation myocardial infarction (STEMI) have had a higher mortality compared with men. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI) with focus on early reperfusion.
Methods We assessed the impact of sex on the outcome of 8,771 patients with acute STEMI who underwent primary PCI from 2003 to 2008 at 32 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry. A propensity-matched analysis was performed to adjust for differences in baseline characteristics and comorbidities between men and women.
Results Twenty-nine percent of the cohort was female. Compared with men, women were older and had more comorbidity. Female sex was associated with a higher unadjusted in-hospital mortality (6.02% vs 3.45%, odds ratio [OR] 1.79, 95% CI 1.45–2.22, P < .0001) and higher risk of contrast-induced nephropathy (OR 1.75, P < .0001), vascular complications (OR 2.13, P < .0001), and postprocedure transfusion (OR 2.84, P < .0001). The gap in sex-specific mortality narrowed over time. In a propensity-matched analysis, female sex was associated with a higher rate of transfusion (OR 1.88, 95% CI 1.57–2.24, P < .0001) and vascular complications (OR 1.65, 95% CI 1.26–2.14, P < .0002); but there was no difference in mortality (OR 1.30, 95% CI 0.98–1.72, P = .07).
Conclusions Women make up approximately one third of patients undergoing primary PCI for STEMI. Female sex is associated with an apparent hazard of increased mortality among patients undergoing primary PCI for STEMI, but this difference is likely explained by older age and worse baseline comorbidities among women.
Coronary heart disease (CHD) is a leading cause of death among men and women in the United States. As of 2005, approximately 1 of every 5 deaths in the United States was due to CHD, with an estimated 150,000 due to myocardial infarction (MI). Over the past several decades, overall CHD death rates have declined; and a corresponding decrease in mortality due to MI has been observed. However, acute coronary syndromes (ACSs) remain a significant cause of mortality, particularly for women. Several studies have demonstrated higher mortality rates for women with ACSs compared with men. Some studies have noted that factors including age, comorbidities, and/or disease severity account for much of the differences in mortality rates between men and women. In contrast, other studies have noted an independent association for female sex associated with increased mortality after ACS. In a recent study using data from the Get With the Guidelines–Coronary Artery Disease (GWTG-CAD) database, higher mortality rates were observed among women admitted with ST elevation myocardial infarction (STEMI) as compared with men, whereas sex did not impact outcome of patients with non–ST elevation ACS. However, changes in percutaneous coronary intervention (PCI) practice and quality initiatives aimed at reducing door-to-balloon times may have influenced these sex-related differences over time.
The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) is a statewide, multihospital quality improvement initiative focused on patients undergoing PCI and, as such, provides a real-life observational cohort of men and women undergoing primary PCI for STEMI. Using these data, we evaluated the outcomes among patients with acute STEMI who underwent PCI to examine the impact of sex on clinical outcomes including mortality.
Abstract and Introduction
Abstract
Background Historically, women with ST elevation myocardial infarction (STEMI) have had a higher mortality compared with men. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI) with focus on early reperfusion.
Methods We assessed the impact of sex on the outcome of 8,771 patients with acute STEMI who underwent primary PCI from 2003 to 2008 at 32 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry. A propensity-matched analysis was performed to adjust for differences in baseline characteristics and comorbidities between men and women.
Results Twenty-nine percent of the cohort was female. Compared with men, women were older and had more comorbidity. Female sex was associated with a higher unadjusted in-hospital mortality (6.02% vs 3.45%, odds ratio [OR] 1.79, 95% CI 1.45–2.22, P < .0001) and higher risk of contrast-induced nephropathy (OR 1.75, P < .0001), vascular complications (OR 2.13, P < .0001), and postprocedure transfusion (OR 2.84, P < .0001). The gap in sex-specific mortality narrowed over time. In a propensity-matched analysis, female sex was associated with a higher rate of transfusion (OR 1.88, 95% CI 1.57–2.24, P < .0001) and vascular complications (OR 1.65, 95% CI 1.26–2.14, P < .0002); but there was no difference in mortality (OR 1.30, 95% CI 0.98–1.72, P = .07).
Conclusions Women make up approximately one third of patients undergoing primary PCI for STEMI. Female sex is associated with an apparent hazard of increased mortality among patients undergoing primary PCI for STEMI, but this difference is likely explained by older age and worse baseline comorbidities among women.
Introduction
Coronary heart disease (CHD) is a leading cause of death among men and women in the United States. As of 2005, approximately 1 of every 5 deaths in the United States was due to CHD, with an estimated 150,000 due to myocardial infarction (MI). Over the past several decades, overall CHD death rates have declined; and a corresponding decrease in mortality due to MI has been observed. However, acute coronary syndromes (ACSs) remain a significant cause of mortality, particularly for women. Several studies have demonstrated higher mortality rates for women with ACSs compared with men. Some studies have noted that factors including age, comorbidities, and/or disease severity account for much of the differences in mortality rates between men and women. In contrast, other studies have noted an independent association for female sex associated with increased mortality after ACS. In a recent study using data from the Get With the Guidelines–Coronary Artery Disease (GWTG-CAD) database, higher mortality rates were observed among women admitted with ST elevation myocardial infarction (STEMI) as compared with men, whereas sex did not impact outcome of patients with non–ST elevation ACS. However, changes in percutaneous coronary intervention (PCI) practice and quality initiatives aimed at reducing door-to-balloon times may have influenced these sex-related differences over time.
The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) is a statewide, multihospital quality improvement initiative focused on patients undergoing PCI and, as such, provides a real-life observational cohort of men and women undergoing primary PCI for STEMI. Using these data, we evaluated the outcomes among patients with acute STEMI who underwent PCI to examine the impact of sex on clinical outcomes including mortality.