Abstract 4321: Women With ST Elevation Myocardial Infarction Treated With Primary PCI Have Worse Outcomes Than Men in the Modern Era: Results From the APEX-AMI Trial
Background: Women with ST elevation myocardial infarction had poor outcomes in prior fibrinolytic trials. It is unclear whether gender-based differences remain with primary PCI.
Methods: In the APEX-AMI trial (7/2004 –5/2006), we examined the largest cohort of women and men undergoing primary PCI in the modern era to determine if differences in death, stroke or bleeding still exist and what factors may explain them.
Results: A total of 1325 of 5745 (23%) patients were women. Women were older (median age 68 vs 60, p<0.001), more often had D M (19.6% v. 14.8%, p<0.001), HTN (60.5% v 46.1%, p<0.001), and prior stroke (5.8 v. 3.1%, p<0.001). Women less often had prior CAD or were smokers (35.6% v. 45.5% p<0.001) but presented with higher Killip class (p trend <0.001). Women had longer median time from symptom onset to PCI (3.6 hr v. 3.3 hr), but similar door to PCI time (1.1 hr). Women were less likely to receive GP IIb/IIIa inhibitors (65.1 v. 70.7%, p<0.001), aspirin (98. 7 v. 99.5, p=0.001), and thienopyridines (92.8% v. 95.2%, p=0.001). Both sexes had similar infarct location and initial vessel patency (TIMI 0 flow 62.8% v. 64.9%) but post-procedural TIMI flow was worse in women (TIMI 0/1 4.6% v. 3.0% p=.02). Women had more severe bleeding (9.5% v. 3.9% p<0.001). There was no difference in stroke rates. Death (see figure⇓) was higher in women but was attenuated when adjusted for baseline patient characteristics (OR 1.68, p<0.001; adjusted OR 1.09, p=NS).
Conclusions: Women have an absolute mortality hazard compared with men following acute MI treated with primary PCI. Gender inherent characteristics and processes of care differences persist that when accounted for attenuate the mortality difference.