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ST elevation myocardial infarction - makes difference being a woman?
Session:
Posters 5 - Écran 9 - Doença Coronária
Speaker:
Joao Pedro Tuna Moura Guedes
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Pedro Moura Guedes; Pedro Oliveira De Azevedo; João De Sousa Bispo; Teresa Faria Da Mota; Raquel Menezes Fernandes; Nuno Marques; Walter Santos; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction: </strong>ST elevation myocardial infarction (STEMI) in women has been associated to poor prognosis in several studies and records.</p> <p><strong>Purpose: </strong>Evaluate the differences of STEMI treatment between men and women and to assess the impact of the female sex (FS) in prognosis</p> <p><strong>Methods: </strong>Retrospetive and multicenter study, based on a national register from 30/10/2010 to 09/19/2017. All patients with STEMI were included. Two groups were established, men and women. It was carried out univariate and multivariate analysis of clinical history, hospitalization dat and treatment strategies.</p> <p><strong>Results: </strong>Analysis identified 6757 patients, 5094 men (75.4%) and 1663 women (24.6%).</p> <p>Women, comparing with men, had higher age (70vs61years, p<0.01), were less frequently: pre-hospital medical transport, admission by STEMI network and admission directly in the catheterization laboratory (cath lab). Women were less frequently subjected to reperfusion therapy (76.5%vs85,1%, p<0.01), had higher times symptoms-balloon and door-to-balloon (D-B). In coronary angiography radial access coronary was used less often and women were submitted to coronary angioplasty (PCI) with less frequently than men (80.4%vs89,2%, p<0.01). The left ventricular ejection fraction (LVEF) <50% was more frequent in women and the rate of complications (intra-aortic balloon, temporary pacemaker, mechanical ventilation, congestive heart failure (HF), cardiogenic shock, atrial fibrillation, mechanical complication, AV block and major bleeding).</p> <p>FS was associated to an increase in intra-hospital mortality (IHM) (9,2vs3,8%, p<0.01), stroke (1.8%vs0,5%, p<0,01) and MACE (composite endpoint: IHM, re-infarction, nonfatal stroke (11,2%vs5,0% p<0.01).</p> <p>In multivariate analysis the FS was not an independent predictor (IP) of IHM (p=0.6; OR 0,73-1,75), MACE (p=0.4; 0.81-1.67), HF (p=0.2; OR 0,94-1,40), re-infarction (p=0.5; OR 0,33-1,70), and LVEF <50% (p<0.01; OR 1,99-8,66) and was IP of stroke (p<0.01; OR 1,99-8,66).</p> <p>FS was IP to not be admitted by STEMI network (p<0.01, OR 0,58-0,79), not be admitted directly in the cath lab (p=0.03, OR CI 0.73-0.98), had a time D-B >90min (p<0.01, 1.07-1.47), anddo not perform reperfusion (p=0.04, 0.70-0.99) and PCI (p<0.01, 0.44-0.83).</p> <p> </p> <p><strong>Conclusions:</strong></p> <p>In patients with STEMI:</p> <ul> <li>Female sex was associated with worse prognosis and greater number of complications.</li> <li>Female sex was not a IP of poor prognosis (death, MACE, re-infarction, HF, LVEF<50%), except for the increase rate of stroke.</li> <li>Being women was IP to not be admitted by STEMI network, not be admitted directly in the cath lab, had a time P-B >90min and do not perform reperfusion and PCI. All these factors known to negatively influence the prognosis of STEMI.</li> <li>In this study, we can conclude that in this population the worst prognosis associated with female sex is not due to the genre itself, but the worst treatment given to women with STEMI.</li> </ul>
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