Abstract 995: Is Gender Still Relevant to the Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarcation in the Contemporary Era? Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Background: Historically, women with STEMI have had a higher mortality compared with men. It is unclear if these differences persist among patients undergoing contemporary primary PCI with focus on early reperfusion.
Methods: We assessed the impact of gender in 8770 patients with acute STEMI who underwent primary PCI from 2003–2008 at 32 hospitals in the BMC2 PCI registry. A propensity matched analysis was performed to adjust for differences in baseline characteristics and co-morbidities between men and women.
Results: Twenty-nine percent of the cohort was female. Compared with men, women were older (65.1 vs 58.3, p<0.0001), more likely to have diabetes (27.1% vs 20.7%, p<0.0001) and present with cardiogenic shock (14.5% vs 9.9%, p<0.0001). Female gender was associated with a higher unadjusted in-hospital mortality (6.02% versus 3.45%, OR 1.79, 95% CI 1.4 –2.2, P<0.0001) and higher risk of contrast induced nephropathy (OR 1.65, 95% CI 1.4 –2.0, P<0.0001), vascular complications (VC) (OR 2.13, 95% CI 1.7–2.6, P<0.0001) and provision of transfusion (Tx)(OR 2.84, 95% CI 2.5–3.2, P<0.0001). The gap in gender specific mortality narrowed over time (Figure 1⇓). In a propensity matched analysis, female gender was associated with a higher rate of Tx (OR 1.86, 95% CI 1.4 –2.4, P<0.001) and VC(OR 1.96, 95% CI 1.7–2, P<0.001) but not with survival (OR 1.18, 95% CI 0.9–1.5, P=0.17).
Conclusions: Women make up approximately one third of patients undergoing primary PCI for STEMI. Female gender is associated with an apparent hazard of increased mortality among patients undergoing primary PCI for STEMI, but this difference may be explained by older age and worse baseline co-morbidities among women.