Abstract 3792: Influence of Gender on the Extent of Myocardial Viability After Primary Coronary Angioplasty
Objectives: Few studies have been addressed about sex distinctions in the amount of jeopardized myocardium that is salvaged by mechanical reperfusion in patients with acute myocardial infarction (AMI). The aim of our study was to evaluate possible gender-related differences in tissue viability after ST elevation myocardial infarction (STEMI) by using myocardial contrast echocardiography (MCE).
Methods: We studied 110 consecutive patients who underwent successful primary coronary angioplasty within 6 h of onset of STEMI. Two-dimensional echocardiography (2DE) was performed within 24 hours of coronary recanalization and microvascular perfusion was assessed by real-time MCE on 7±2 days after AMI. Contrast defect length (CDL%) was measured to assess microvascular integrity on endocardial border. Myocardial viability index was obtained by summing perfused but dysfunctioning segments divided by all dysfunctional segments and expressed as percentage.
Results: Of the 110 patients received primary PCI, 28 patients were females (26%) and 82 (74%) were males. Women were significantly older and had a longer time to reperfusion (8.6 + 7.1 hours vs 4.5 + 4.2 hours in men, p=0.011). Contrast defect length was larger in men than women (20 + 7.2 % vs 11 + 7.0 %, respectively, p=0.009) suggesting the presence of a bigger microvascular damage. Myocardial viability index was higher in women than in men (56 + 37 % vs 33 + 22 %, respectively, p=0.016). Multiple linear regression analysis was used to assess the independent impact of gender on myocardial viability. After adjustment for other variables, female gender, younger age, anterior infarction, shorter time to reperfusion, small contrast defect length and the use of glycoprotein IIb/IIIa inhibitors were identified as independent factors of higher myocardial viability.
Conclusions: In successfully reperfused STEMI population, myocardial viability as detected by MCE is gender-dependent also after adjusting for other baseline and risk factors. A different response to antiaggregating drugs, a higher tolerance to hypoxic setting and the activation of estrogen receptors against intracellular calcium loading could probably be involved in this favorable women behavior.