Sex Differences in Short-Term and Long-Term All-Cause Mortality Among Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Intervention: A Meta-Analysis

Study Questions:

Do gender differences exist for mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI)?

Methods:

This was a meta-analysis which used several databases of published literature including MEDLINE, EMBASE, and Cochrane databases. No restrictions in publication dates were used. Inclusion criteria for studies were that the publications included patients with STEMI, primary PCI (performed within 12 hours of symptoms onset) was the treatment for STEMI, and sex-specific in-hospital and/or 1-year mortality rates were reported. These could be either observational or randomized clinical trials. Quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale for cohort studies. Primary outcomes of interest were sex-specific in-hospital and 1-year all-cause mortality.

Results:

A total of 18,555 women and 49,981 men were included from 35 studies which met inclusion criteria (from 149 studies identified). In most studies, women were more likely to be older and have diabetes, hypertension, and/or dyslipidemia compared to the men. In the unadjusted analyses, women were at a higher risk for in-hospital (relative risk [RR], 1.93; 95% confidence interval [CI], 1.75-2.14; p < 0.001, I2 = 14%) and 1-year all-cause mortality (RR, 1.58; 95% CI, 1.36-1.84; p < 0.001, I2 = 51%) compared with men. However, when adjusted RRs were used, the association between women and higher risk of all-cause mortality was attenuated, but still significantly elevated for in-hospital mortality (RR, 1.48; 95% CI, 1.07-2.05; p = 0.02; I2 = 56%). The higher risk for 1-year mortality in women was no longer significant (RR, 0.90; 95% CI, 0.69-1.17; p = 0.42; I2 = 58%).

Conclusions:

The authors found that an increased mortality in women with STEMI treated with primary PCI was observed. However, this was likely confounded by baseline cardiovascular risk factors and the differences in clinical profile of male and female patients.

Perspective:

These data suggest that women may be at increased risk for worse outcomes after PCI for STEMI; however, risk factors appear to contribute to some of this risk. Efforts to control risk factors in women many improve survival in the setting of STEMI.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Hypertension

Keywords: Dyslipidemias, Myocardial Infarction, Hospital Mortality, Risk Factors, Hypertension, Diabetes Mellitus, Percutaneous Coronary Intervention


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