Abstract 4318: Is Female Gender Still an Independent Predictor of In-Hospital Mortality After STEMI in the Era of Primary PCI? Insights From the Greater Paris Area PCI Registry
BACKGROUND: A higher early mortality rate after STEMI has been reported in women before the widespread use of PCI in STEMI. PCI improves the prognosis of STEMI; however, the effect of primary PCI on early outcomes in women is controversial. In a large regional prospective registry, we examined in-hospital mortality after PCI for STEMI in women and men to determine if female gender was still an independent predictor of in-hospital mortality.
METHODS: The Greater Paris area comprises 11 million inhabitants and accounts for 18% of the French population. Data from all PCIs performed in the 42 centers of this area is entered in a mandatory registry with internal and external audits held by the hospital governmental agency. Clinical status at discharge (dead or alive) is also recorded in another hospital-based database and a cross-check performed to validate all deaths. From 2003 to 2007, 16063 patients were treated by PCI for STEMI within 24 hours of the onset of chest pain, 3542 (22.0%) were women and 12521 (78%) men. Quantitative variables were compared using Student’s test and qualitative variables by a chi-square test. Odds ratios (ORs) of in-hospital mortality were calculated using logistic regression models.
RESULTS: The rate of transfusion and/or vascular surgery was significantly higher in women (1.5% versus 0.4% in men, p<.0001). By multivariate analysis, independent predictors for in-hospital mortality were: female gender (Odds ration (OR): 1.36 [1.09 –1.69] p=0.006), age (1.06 [1.05–1.07] p<.0001), diabetes mellitus (1.69 [1.33–2.16] p<.0001), cardiogenic shock (22.42 [17.35–28.98] p<.0001), left main stenosis (1.92 [1.33–2.77] p<0.001). PCI success was a predictor for survival (0.21 [0.14 – 0.30] p<.0001).
CONCLUSION: After PCI for STEMI, female gender is still an independent predictor of in-hospital mortality.