Sex-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty: Data from the Zwolle Myocardial Infarction study

Background Several studies have found that among patients with ST-elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. The aim of this study was to investigate sex-related differences in clinical and angiographic findings and in long-term outcome in patients with STEMI treated with primary angioplasty. Methods Our population is represented by 1548 consecutive patients with STEMI treated by primary angioplasty from April 1997 to October 2001. All clinical, angiographic, and follow-up data were prospectively collected. Results Among 1548 patients, 353 were women (22.8%). Female sex was associated with more advanced age, higher prevalence of diabetes, hypertension, more advanced Killip class, longer ischemia time, and smaller vessel caliber. No difference was observed in terms of procedural success, postprocedural epicardial flow, myocardial perfusion, ST-segment resolution, and enzymatic infarct size. At 1-year follow-up, female sex was associated with a significantly higher 1-year mortality rate at univariate (9.3% vs 4.9 %, RR [95% CI] = 1.79 [1.14 to 2.8], P = .002) but not at multivariate analysis (RR [95% CI] = 1.41 [0.86 to 2.32], P = NS). Conclusions This study shows that in patients with STEMI treated by primary angioplasty, women are associated with higher mortality rate in comparison with men, mainly because of their high-risk profile and angiographic features. Female sex did not emerge as an independent predictor of death.