Author + information
- Shirley Edwards,
- Brittany Wagman,
- Han Tun,
- Ray V. Matthews,
- Anilkumar Mehra,
- Michael Gaglia,
- Leonardo Clavijo and
- David M. Shavelle
Previous studies suggest that women undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) experience increased complications (bleeding) and mortality compared to men.
The Los Angeles County+USC and Keck Hospital PCI Database were queried from January, 2008 to December, 2012 to identify all patients undergoing PCI with a diagnosis of AMI, including STEMI and NSTEMI. Eight hundred seventy-two patients were included: 182 women (21%) and 690 men (79%). Predictors of in-hospital mortality were determined using multivariable logistic regression analysis.
Women were older and had a higher prevalence of diabetes and hypertension compared to men (Table). The prevalence of insulin dependence was higher and overall diabetes control was significantly worse for women compared to men. In contrast, men had a significantly higher prevalence of metabolic syndrome. The number of diseased vessels and number of bare metal and drug eluting stents received were similar between genders; women had a higher prevalence of left main disease. There was a trend for a higher prevalence of cardiogenic shock in women compared to men and intra-aortic balloon pump use was significantly higher in women. Unadjusted in-hospital mortality and occurrence of stroke was higher in women compared to men. However, after multivariable logistic adjustment for baseline differences, female gender was no longer associated with increased in-hospital mortality.
In AMI patients receiving PCI, females had increased unadjusted in-hospital mortality when compared to males. Baseline differences between genders, including age, ethnicity and severity of diabetes mellitus, explain this increase in mortality.
|Age, years||63 +/- 12||57 +/- 10||<0.0001|
|Hispanic||119 (65%)||361 (52%)||0.002|
|Diabetes mellitus||92 (51%)||225 (33%)||<0.0001|
|Insulin dependent||55 (30%)||122 (18%)||0.0002|
|HgA1c||7.8 +/- 2.2||7.1 +/- 2.2||0.01|
|Metabolic syndrome||65 (34%)||329 (48%)||0.0003|
|Hypertension||144 (79%)||468 (68%)||0.01|
|Stroke||4 (2.2%)||1 (0.14%)||0.008|
|In-hospital mortality||16 (8.8%)||23 (3.3%)||0.006|