Sex-specific treatment effects after primary percutaneous intervention : A study on coronary blood flow and delay to hospital presentation
Cenko, Edina (Department of Experimental. Diagnostic and Specialty Medicine. University of Bologna)
van der Schaar, M. (University of Cambridge)
Yoon, J. (Department of Electrical and Computer Engineering. University of California)
Kedev, Sasko (Medical Faculty. University Clinic of Cardiology. University "Ss Cyril and Methodius,")
Valvukis, M. (Medical Faculty. University Clinic of Cardiology. University "Ss Cyril and Methodius,")
Vasiljevic, Z. (School of Medicine. University of Belgrade)
Ašanin, M. (Department of Cardiology. Clinical Centre of Serbia)
Miličić, D. (Department for Cardiovascular Diseases. University Hospital Center Zagreb. University of Zagreb)
Manfrini, Olivia (Department of Experimental. Diagnostic and Specialty Medicine. University of Bologna)
Badimon, Lina (Institut d'Investigació Biomèdica Sant Pau)
Bugiardini, Raffaele (Department of Experimental. Diagnostic and Specialty Medicine. University of Bologna)
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	Background We hypothesized that female sex is a treatment effect modifier of blood flow and related 30-day mortality after primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction and that the magnitude of the effect on outcomes differs depending on delay to hospital presentation. Methods and Results We identified 2596 patients enrolled in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry from 2010 to 2016. Primary outcome was the occurrence of 30-day mortality. Key secondary outcome was the rate of suboptimal post-PCI Thrombolysis in Myocardial Infarction (TIMI; flow grade 0-2). Multivariate logistic regression and inverse probability of treatment weighted models were adjusted for baseline clinical covariates. We characterized patient outcomes associated with a delay from symptom onset to hospital presentation of ≤120 minutes. In multivariable regression models, female sex was associated with postprocedural TIMI flow grade 0 to 2 (odds ratio [OR], 1. 68; 95% CI, 1. 15-2. 44) and higher mortality (OR, 1. 72; 95% CI, 1. 02-2. 90). Using inverse probability of treatment weighting, 30-day mortality was higher in women compared with men (4. 8% versus 2. 5%; OR, 2. 00; 95% CI, 1. 27-3. 15). Likewise, we found a significant sex difference in post-PCI TIMI flow grade 0 to 2 (8. 8% versus 5. 0%; OR, 1. 83; 95% CI, 1. 31-2. 56). The sex gap in mortality was no longer significant for patients having hospital presentation of ≤120 minutes (OR, 1. 28; 95% CI, 0. 35-4. 69). Sex difference in post-PCI TIMI flow grade was consistent regardless of time to hospital presentation. Conclusions Delay to hospital presentation and suboptimal post-PCI TIMI flow grade are variables independently associated with excess mortality in women, suggesting complementary mechanisms of reduced survival.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	ST-segment-elevation myocardial infarction ; Coronary blood flow ; Mortality ; Sex differences
Publicado en:	Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol. 8 Núm. 4 (2019) , p. e011190, ISSN 2047-9980

DOI: 10.1161/JAHA.118.011190
PMID: 30764687

29 p, 937.3 KB

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