Women may be at higher risk for mortality after primary PCI for STEMI

Compared with men, women who underwent primary PCI for STEMI were at a significantly increased risk for in-hospital mortality in adjusted analysis and both in-hospital and 1-year mortality in unadjusted analysis, according to data published in JAMA Internal Medicine. 

In the meta-analysis, researchers culled studies in which patients presented with STEMI; primary PCI was the treatment; primary PCI was performed within 12 hours of symptom onset; and sex-specific in-hospital and/or 1-year mortality were reported.

Sex-specific in-hospital and 1-year all-cause mortality served as the primary outcome measures.

The researchers identified 149 studies, 35 of which met the inclusion criteria. The analysis included 18,555 women and 49,981 men. The researchers said female patients tended to have a poorer baseline CV risk profile, were older at presentation, and had a higher prevalence of diabetes, hypertension and dyslipidemia.

According to unadjusted analysis, women were at increased risk for in-hospital (RR=1.93; P<.001) and 1-year all-cause (RR=1.58; P<.001) mortality. After adjustment for confounders or studies with a lack of sufficient power, the association remained, although was decreased, with in-hospital mortality (RR=1.48; P=.02), but not 1-year mortality (RR=0.9; P=.42).

The researchers wrote that the findings are possibly confounded by baseline differences in CV risk profile and clinical profile at the time of STEMI presentation.

“Considering the limitations of the data from the included studies, our results should serve as hypothesis generating and stimulate further research with robust strategies for risk adjustment to elucidate this hypothesis more accurately,” they wrote. “Because most of these risk factors are modifiable, appropriate measures to optimize health care utilization in women may reduce this gender gap.”

Disclosure: One researcher reports receiving speaker fees from Pfizer and Terumo and a research grant from Accumed Radial Systems. The other researchers report no relevant financial disclosures.

Source: www.healio.com