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Worse Prognosis for Women Who Underwent Primary

519

Suphot Srimahachota*,
Smonporn Boonyaratavej*, Wasan Udayachalerm*,
Wacin Buddhari*, Jarkarpun Chaipromprasit*,
Taworn Suithichaiyakul*, Yeesune Sukseri*

Abstract


Background : Many reports have shown that female gender carries a worse prognosis when developing
acute myocardial infarction (MI), whether or not reperfusion therapy is used. The primary percutaneous
coronary intervention (1-PCI) is currently a preferable treatment for acute ST-elevation MI. However, the
data concerning the difference between the outcomes in the treatment of the disease in men and women in
Thailand is still insufficient.
Material and Method : A prospective registry of acute ST-elevation MI patients who underwent 1-PCI at
King Chulalongkorn Memorial Hospital from June 1999 to December 2002 were analyzed. Kaplan Meier
survival analysis is used to determine the in-hospital mortality.
Results : The consecutive 184 (F-52, M-131) patients who underwent 1-PCI were recruited. Female subjects
were older (66.6 + 12 y versus 59.0 + 11.6 y, p < 0.01); they also had higher percentage of diabetes (45.1
versus 27.1, p < 0.01), but a fewer number of smoker (17.7 versus 66.2, p < 0.001). The percentage of patients
who had cardiogenic shock tended to be higher in women (34.6 versus 19.9, p = 0.08); however, the number
of anterior wall MI and ejection fraction were not different. The mean door to balloon time (109 + 95 versus
99 + 68 minutes) and pain to balloon time (454 + 271 versus 372 + 298 minutes) were not different in both
groups. The angiographic success with TIMI 3 flow was achieved in 92.3% for females and 86.9% for the
males. The in-hospital mortality was significantly higher in females (23.1 versus 6.1, p = 0.002). Univariate
analyses demonstrated that the feminine gender, cardiogenic shock, smoking, ejection fraction less than 40,
cardiac arrest prior PCI and angiographic were the predictors for in-hospital mortality. When using
multivariate analyses by Cox proportional model, only cardiogenic shock, history of hypertension and
angiographic success were the significant predictors. Women had 2.15 times of in-hospital mortality higher
than males; however, the confidence interval cross-over 1 (0.74-6.42) and p value was 0.16.
Conclusion : Females tend to have a poor prognosis when they develop acute ST-elevation MI which
requires treatment with 1-PCI.

Keyword : Primary percutaneous coronary intervention, Acute myocardial infarction, Female



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