Infarct Size and Clinical Outcomes in Women After Primary PCI

Study Questions:

Do women have worse outcomes than men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) because of larger infarct size and lower left ventricular ejection fraction (LVEF)?

Methods:

Patient-level data from 10 randomized primary PCI trials were pooled. Sex differences in infarct size (measured by cardiac MRI or SPECT within 1 month) and LVEF were assessed with respect to the composite outcome of death or heart failure (HF) hospitalization within 1 year.

Results:

Women accounted for 22.3% (587) of the 2,632 patients with STEMI undergoing primary PCI. There was no sex difference in infarct size and women had higher LVEF; however, women still had worse 1-year outcomes (death, HF admission). Women were older, more likely to have diabetes and prior MI, and less likely to have restoration of TIMI 3 flow. Even when adjusted for age and baseline differences, women had more HF and death. Women had longer delay to reperfusion, but did not have larger infarct size.

Conclusions:

Women have worse outcomes after primary PCI for STEMI than men, despite having higher LVEF and no difference in infarct size.

Perspective:

It is known that women have worse outcomes after STEMI, but the underlying mechanisms are not fully understood. According to these results, this disparity cannot be explained by differences in infarct size or LVEF, even when adjusted for age and other covariates. Therefore, these findings lead to more questions. Possible explanations for women having worse outcomes include higher prevalence of diastolic dysfunction, microvascular disease, and inflammatory response. Women may also have differences in plaque characteristics, hormones, pulmonary vascular function, or rates of medication prescription and compliance. Further research into sex differences is clearly indicated.

Clinical Topics: Acute Coronary Syndromes, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Acute Heart Failure, Chronic Heart Failure, Interventions and ACS, Interventions and Imaging, Computed Tomography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Diabetes Mellitus, Geriatrics, Heart Failure, Heart Failure, Diastolic, Myocardial Infarction, Magnetic Resonance Imaging, Percutaneous Coronary Intervention, Prognosis, Reperfusion, Sex Characteristics, Stroke Volume, Tomography, Emission-Computed, Single-Photon, Ventricular Function, Left, Women


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