Abstract 13070: Clinical Characteristics and Outcomes in Japanese Women With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Background: Previous studies have shown higher mortality in women than in men with acute myocardial infarction (AMI). Limited data are available for sex-based differences in patients with AMI undergoing percutaneous coronary intervention (PCI). Purpose: To clarify sex-based differences in risk factor profiles and outcomes among Japanese patients with AMI undergoing PCI.
Methods: The CREDO-Kyoto AMI registry is a registry of Japanese patients with AMI undergoing PCI in 2005-2007 at 26 hospitals in Japan. The study subjects consisted of 1197 women and 3182 men enrolled in the registry. Patients with malignant disease were not included. The outcome measures were all-cause death (AD), cardiovascular death (CVD), major adverse cardiovascular events (MACE) as the composite of CVD, myocardial infarction and stroke, and any coronary revascularization (ACR).
Results: A mean follow-up period was 1090 days. Compared with men, women were older and more frequently had histories/comorbid conditions of heart failure, hypertension, chronic kidney disease, anemia, dyslipidemia, cardiogenic shock and lower peak creatinine phosphokinase levels (women: 2337 IU/L, men: 3257 IU/L, p=<0.0001). Women had a higher incidence of in-hospital death (8.9% vs. 4.9%, p<0.0001) and less likely to be prescribed cardioprotective drugs such as ACE inhibitors/ARBs and beta-blockers. Cumulative incidences of AD, CVD and MACE at 3 years were significantly higher in women (AD, 17.7% vs. 10.7%, log-rank p<0.0001; CVD, 14.4% vs. 7.8%, p<0.0001; MACE, 21.0% vs. 13.9%, p<0.0001). However, the adjusted risks for AD, CVD and MACE were comparable between women and men [AD, relative risk (RR) 0.98, 95% confidence interval (CI) 0.79-1.20, p=0.82; CVD, RR 1.04, 95% CI 0.82-1.33, p=0.74; MACE, RR 1.11, 95% CI 0.92-1.34, p=0.26]. The incidence of ACR was significantly lower in women than in men (29.3% vs. 36.7%, p=0.0004), and an adjusted risk for ACR remained significantly lower in women than in men (RR 0.83, 95% CI 0.72-0.94, p=0.004).
Conclusions: The risk for ACR was significantly lower in Japanese female than in male patients with AMI undergoing primary PCI. Although unadjusted incidences of death, CVD and MACE were higher in women, these outcome measures became comparable after adjustment.
- © 2011 by American Heart Association, Inc.