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.

ABSTRACT

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.