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Sex disparities in mid-term outcomes of ST-segment elevation myocardial infarction across age
Session:
Comunicações Orais - Sessão 09 - Síndrome coronária aguda 1
Speaker:
Mariana Pereira Santos
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Pereira Santos; David Sá-Couto; André Alexandre; Andreia Campinas; Diana Ribeiro; Raquel Baggen Santos; Bruno Brochado; João Silveira; André Luz; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Background</strong>: Women with ST-segment elevation myocardial infarction (STEMI) have been reported to have higher short-term mortality than men, especially younger patients. However, data on long-term outcomes did not corroborate this association.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Purpose</strong>: We aimed to evaluate if sex was a predictor of major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up when corrected to other clinical and demographic characteristics. A sub-analysis across different age subgroups was performed. </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Methods</strong>: We retrospectively studied consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. Cox proportional hazard models were used to identify predictors of MACCE at 1-year follow-up (death, cerebrovascular accident, new myocardial infarction in any vessel, or target lesion revascularization). Patients were divided into four age groups, according to quartiles, for subgroup analysis (≤50, 51-60, 61-70, >71 years). </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Results:</strong> Of the 1131 patients included in the study, 291 (25.7%) were women. Women were older [68.2 (±14.2) vs 60.6 (±12.2) years, p<0.001], more often non-smokers (21.5% vs 60.2%, p<0.001), and had a higher prevalence of diabetes (34,8% vs 20.9%, p<0.001) and hypertension (71.6% vs 50.2%, p<0.001). They also had lower haemoglobin [12.8(±1.6) vs 14.5(±1.7) g/dl, p<0.001] and lower creatinine clearance at admission [73.8(±35.3) vs 92.6(±35.2) ml/min, p<0.001], as well as longer door-to-balloon times [90(60-166) vs 75(50-120) min, p=0.005]. Total ischemic time was not significantly different between groups [250 (175-480) vs 224(150-440) min, p=0.054].</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Overall, women had a higher occurrence of MACCE (22.1% vs 15.4%; log-rank P = 0.008). On multivariate analysis, sex was not found to be an independent predictor of MACCE (HR 1.12; 95% CI 0.77–1.65; P=0.547). The risk of unfavourable outcomes was mainly driven by other comorbidities (namely, age, presence of peripheral arterial disease, lower haemoglobin concentration, lower systolic blood pressure on admission, a higher peak CK activity, and the utilization of a femoral approach). When MACCE was stratified for age, sex was not an independent predictor of MACCE in any age group (Figure 1).</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Conclusion</strong>: Women with STEMI submitted to PCI had a higher rate of MACCE at 1-year follow-up compared with men, however, sex was not an independent predictor of these events on multivariate analysis, regardless of the age subgroups considered.</span></span></p>
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