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Do gender differences in primary PCI mortality represent a different adherence to guideline recommended therapy? a multicenter observation.

Birkemeyer R, Schneider H, Rillig A, Ebeling J, Akin I, Kische S, Paranskaya L, Jung W, Ince H, Nienaber CA - BMC Cardiovasc Disord (2014)

Bottom Line: Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males.Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months.Adjusted mortality however did not differ significantly between genders.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Heart Center Rostock, Medizinische Klinik I, Universitätsklinikum Rostock, Ernst-Heydemann-Str, 6, 18057 Rostock, Germany. rbirkemeyer@t-online.de.

ABSTRACT

Background: It is uncertain whether gender differences in outcome after primary percutaneous coronary intervention (PCI) are only attributable to different baseline characteristics or additional factors.

Methods: Databases of two German myocardial infarction network registries were combined with a total of 1104 consecutive patients admitted with acute ST-elevation myocardial infarction (STEMI) and treated according to standardized protocols.

Results: Approximately 25% of patients were females. Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males. Mean prehospital delay was numerically longer in females (227 vs 209 min) as was in hospital delay (35 vs 30 min). PCI was finally performed in 92% of females and 95% of males with comparable procedural success (95% vs 97%). Use of drug eluting stents (55% vs 68%) and application of GP 2b 3a blockers (75% vs 89%) was significantly less frequent in women. At discharge, prescription of beta blockers and lipid lowering drugs was also significantly lower in females (84% vs 90% and 71% vs 84%). Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months. Adjusted mortality however did not differ significantly between genders.

Conclusion: Higher unadjusted mortality in females after primary PCI was accompanied by significant differences in baseline characteristics, interventional approach and secondary prophylaxis in spite of the same standard of care. Lower guideline adherence seems to be less gender specific but rather a manifestation of the risk-treatment paradox.

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Death at 12 months. Explanatory variable female gender: unadjusted, adjusted by propensity score, covariates or by covariates with propensity score as additional covariate (details under “Statistical methods”).
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Figure 1: Death at 12 months. Explanatory variable female gender: unadjusted, adjusted by propensity score, covariates or by covariates with propensity score as additional covariate (details under “Statistical methods”).

Mentions: Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%, p < 0.01). Difference persisted during the first year without attenuation (15% vs 7%, p < 0.01). Re-infarction, target lesion revascularisation and target vessel revascularisation rates were numerically lower in females within the first year after the index event (Table 5).However, after adjustment by propensity score or covariates, female gender failed to be predictive as explanatory variable for 12 month mortality (Figure 1).


Do gender differences in primary PCI mortality represent a different adherence to guideline recommended therapy? a multicenter observation.

Birkemeyer R, Schneider H, Rillig A, Ebeling J, Akin I, Kische S, Paranskaya L, Jung W, Ince H, Nienaber CA - BMC Cardiovasc Disord (2014)

Death at 12 months. Explanatory variable female gender: unadjusted, adjusted by propensity score, covariates or by covariates with propensity score as additional covariate (details under “Statistical methods”).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4061506&req=5

Figure 1: Death at 12 months. Explanatory variable female gender: unadjusted, adjusted by propensity score, covariates or by covariates with propensity score as additional covariate (details under “Statistical methods”).
Mentions: Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%, p < 0.01). Difference persisted during the first year without attenuation (15% vs 7%, p < 0.01). Re-infarction, target lesion revascularisation and target vessel revascularisation rates were numerically lower in females within the first year after the index event (Table 5).However, after adjustment by propensity score or covariates, female gender failed to be predictive as explanatory variable for 12 month mortality (Figure 1).

Bottom Line: Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males.Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months.Adjusted mortality however did not differ significantly between genders.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Heart Center Rostock, Medizinische Klinik I, Universitätsklinikum Rostock, Ernst-Heydemann-Str, 6, 18057 Rostock, Germany. rbirkemeyer@t-online.de.

ABSTRACT

Background: It is uncertain whether gender differences in outcome after primary percutaneous coronary intervention (PCI) are only attributable to different baseline characteristics or additional factors.

Methods: Databases of two German myocardial infarction network registries were combined with a total of 1104 consecutive patients admitted with acute ST-elevation myocardial infarction (STEMI) and treated according to standardized protocols.

Results: Approximately 25% of patients were females. Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males. Mean prehospital delay was numerically longer in females (227 vs 209 min) as was in hospital delay (35 vs 30 min). PCI was finally performed in 92% of females and 95% of males with comparable procedural success (95% vs 97%). Use of drug eluting stents (55% vs 68%) and application of GP 2b 3a blockers (75% vs 89%) was significantly less frequent in women. At discharge, prescription of beta blockers and lipid lowering drugs was also significantly lower in females (84% vs 90% and 71% vs 84%). Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months. Adjusted mortality however did not differ significantly between genders.

Conclusion: Higher unadjusted mortality in females after primary PCI was accompanied by significant differences in baseline characteristics, interventional approach and secondary prophylaxis in spite of the same standard of care. Lower guideline adherence seems to be less gender specific but rather a manifestation of the risk-treatment paradox.

Show MeSH
Related in: MedlinePlus