Do gender differences in primary PCI mortality represent a different adherence to guideline recommended therapy? a multicenter observation

BMC Cardiovascular Disorders

Research Article

Andreas Rillig¹  Ralf Birkemeyer²  Henrik Schneider²  Juliane Ebeling²  Liliya Paranskaya²  Stefan Kische²  Ibrahim Akin² 

[1] Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany;Department of Cardiology, Heart Center Rostock, Medizinische Klinik I, Universitätsklinikum Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany;

关键词: Primary PCI;    Myocardial infarction network;    Gender differences;   

DOI  :  10.1186/1471-2261-14-71

 received in 2014-03-23, accepted in 2014-05-29,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundIt is uncertain whether gender differences in outcome after primary percutaneous coronary intervention (PCI) are only attributable to different baseline characteristics or additional factors.MethodsDatabases of two German myocardial infarction network registries were combined with a total of 1104 consecutive patients admitted with acute ST-elevation myocardial infarction (STEMI) and treated according to standardized protocols.ResultsApproximately 25% of patients were females. Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males. Mean prehospital delay was numerically longer in females (227 vs 209 min) as was in hospital delay (35 vs 30 min). PCI was finally performed in 92% of females and 95% of males with comparable procedural success (95% vs 97%). Use of drug eluting stents (55% vs 68%) and application of GP 2b 3a blockers (75% vs 89%) was significantly less frequent in women. At discharge, prescription of beta blockers and lipid lowering drugs was also significantly lower in females (84% vs 90% and 71% vs 84%). Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months. Adjusted mortality however did not differ significantly between genders.ConclusionHigher unadjusted mortality in females after primary PCI was accompanied by significant differences in baseline characteristics, interventional approach and secondary prophylaxis in spite of the same standard of care. Lower guideline adherence seems to be less gender specific but rather a manifestation of the risk-treatment paradox.

【 授权许可】

CC BY   
© Birkemeyer et al.; licensee BioMed Central Ltd. 2014