Abstract 5580: Sex Differences in Outcomes after Myocardial Infarction with Persistent Total Occlusion of the Infarct Artery: Analysis of the Occluded Artery Trial
There are differences in characteristics and outcomes of women and men across the spectrum of ACS. Analysis of the Occluded Artery Trial (OAT) affords the opportunity to examine sex differences in outcomes and the effect of PCI in a relatively homogeneous subset of MI survivors. OAT randomized 484 (22%) women and 1717 (88%) men to PCI of a totally occluded infarct artery or to Medical Therapy alone (MED) 3–28 calendar days post MI and found no benefit of PCI on the composite endpoint of death, MI and class IV heart failure [HF4]. We analyzed outcomes by sex and treatment assignment. P<0.01 was pre-specified as significant for secondary analyses in OAT. Women were older and were more likely to have the LAD as the infarct-related artery, diabetes and hypertension but were less likely to smoke than men. Women were more likely to have history of HF and rales at randomization. Multivessel disease [14.9% among women and 18.1% among men, p<0.10] and LVEF [47.9±11.8 vs. 47.7±10.9, p=0.71] were similar. Women were more likely to have the primary composite endpoint [HR 1.53, 99%CI, 1.11–2.11; p<0.001,] and HF4 [HR 2.77, 99% CI, 1.59 – 4.82; p<0.001]. In the Table⇓ below, showing the event rates by sex and treatment assignment, there was no difference in mortality or reMI between sexes. On multivariate analysis, female sex was independently associated with development of HF4 [HR 2.33, 99%CI 1.32– 4.10, p<0.001], even among those patients who did not have a prior diagnosis of HF [HR 2.73, 99%CI 1.51, 4.93; p<0.001]. Women in OAT had a higher rate of the primary endpoint, which was mainly driven by HF4. Female sex was not independently associated with death, MI or the primary composite. Female sex was independently associated with subsequent development of severe heart failure in this well defined cohort of men and women with comparable extent of CAD and equivalent LVEF. There was no significant difference in the primary outcome for PCI and MED groups in either sex.