Mortality Risk in Women Treated with PCI following STEMI: Insights from the Greater Paris Area PCI Registry

Do women face a higher risk of death compared with men following treatment with primary percutaneous coronary intervention (PCI) following ST elevation myocardial infarction (STEMI)? A study presented during the "Women, STEMI, and PCI Trials" Abstract Oral Session Tuesday morning at the American Heart Association Scientific Sessions 2009 sought to answer that question.

Christian Spaulding, from the CARDIO-ARHIF Scientific Committee + INSERM U 970 in Paris, France presented "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," which analyzed in-hospital mortality data in women and men from a large regional prospective registry to determine if female gender was still an independent predictor of in-hospital mortality after PCI for STEMI. An important question, said Spaulding, because, although previous studies have shown that female gender was an independent predictor of in-hospital mortality after STEMI, the data is inconclusive because PCI was not widely used in the registries from which the data was collected.

The study looked at registry of clinical and angiographic data collected from 42 regional medical centers on all patients who were treated with PCI for STEMI within 24 hours of the onset of chest pain. During the time period of the study, 16,063 patients were treated with PCI for STEMI: 3,542 (22%) women and 12,521 (78%) men. Variables entered into the registry included patient demographics, procedural information, pre- and post-procedural complications, and clinical status at hospital discharge.

The researchers found that female patients in this cohort were on average nearly 10 years older than males (69 years vs. 59 years). They also noted that primary PCI was chosen more often in women compared to thrombolytic therapy, and that the rate of transfusion and/or vascular surgery was significantly higher in women (1.5% versus 0.4% in men). The study found "no real differences in angiographic characteristics," according to Spaulding.

Analysis of the data found that the success rate of primary PCI was lower in women compared with men, and there was a significant difference in in-hospital mortality rates in women (9.8%) compared to men (4.3%). Independent predictors for in-hospital mortality were: female gender, age, diabetes, cardiogenic shock, and left main stenosis.

Based on these results, the researchers concluded that in patients treated with PCI for STEMI, female gender was still an independent predictor of in-hospital mortality after STEMI. Spaulding said these results point to a "clear need for further studies to explain this difference so that gender inequities in clinical care can be eliminated."