eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Original paper

Gender-related differences in men and women with ST-segment elevation myocardial infarction and incomplete infarct-related artery flow restoration: a multicenter national registry

Małgorzata Zachura, Krzysztof Wilczek, Jacek Kurzawski, Marek Gierlotka, Mariusz Gąsior, Marcin Sadowski

Adv Interv Cardiol 2018; 14, 4 (54): 356–362
Online publish date: 2018/12/11
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Little is known about gender-related differences in ST-segment elevation myocardial infarction (STEMI) and incomplete infarct-related artery (IRA) reperfusion after primary percutaneous coronary intervention (pPCI).

To evaluate gender-related differences in clinical characteristics and prognosis in patients with STEMI and incomplete IRA reperfusion after pPCI.

Material and methods
From 42,752 STEMI patients hospitalized between 2009 and 2011 in Poland we analyzed a group of 984 (36%) females and 1,746 (64%) males with less than Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow following pPCI.

Women were older than men (72.0 ±11.3 vs. 64.0 ±11.7 years; p < 0.0001) and in age-adjusted analysis they were more likely to present with hypertension (73.7% vs. 67%; p = 0.0003), diabetes (33% vs. 22.6%; p < 0.0001) and obesity (28.1% vs. 22.6%; p = 0.0016). Heart rate > 100 beats/min was more common in women, while men were more often smokers and presented with sudden cardiac arrest. The most common IRA in women was the left anterior descending artery, and the right coronary artery in men. After adjusting for age statistically significant differences in pharmacotherapy concerned only the use of insulin (OR = 1.31, 95% CI: 1.02–1.68). High risk of death, rehospitalization due to heart failure or cardiac causes, were observed in all patients during the 6-month and 12-month follow-up periods. The risk of heart failure was significantly higher in women than in men. The most significant decrease in survival rates was observed in the in-hospital period.

Among patients with STEMI and post-interventional TIMI flow grade < 3 women have unfavorable baseline characteristics and an adverse short- and long-term prognosis when compared to men.


primary percutaneous coronary intervention, thrombolysis in myocardial infarction, ST-segment myocardial infarction, gender-related differences

The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569-619.
TIMI Study Group. The Thrombolysis In Myocardial Infarction (TIMI) trial. N Engl J Med 1985; 31: 932-6.
Mehta RH, Harjai KJ, Cox D, et al.; Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol 2003; 42: 1739-46.
Kytö V, Sipilä J, Rautava P. Gender and in-hospital mortality of ST-segment elevation myocardial infarction (from a multihospital nationwide registry study of 31,689 patients). Am J Cardiol 2015; 115: 303-6.
Park JS, Kim YJ, Shin DG, et al. Gender differences in clinical features and inhospital outcomes in ST-segment elevation acute myocardial infarction: from the Korean acute myocardial infarction registry (KAMIR) study. Clin Cardiol 2010; 33: E1-6.
Ghaffari S, Pourafkari L, Tajlil A, et al. Is female gender associated with worse outcome after ST elevation myocardial infarction? Indian Heart J 2017; 69 Suppl 1: S28-33.
Poloński L, Gąsior M, Gierlotka M, et al. Polish Registry of Acute Coronary Syndromes (PL-ACS). Characteristics treatments and outcomes of patients with acute coronary syndromes in Poland. Kardiol Pol 2007; 65: 861-72.
Shiraishi J, Kohno Y, Sawada T, et al. Predictors of nonoptimal coronary flow after primary percutaneous coronary intervention with stent implantation for acute myocardial infarction. J Cardiol 2010; 55: 217-23.
Barthélémy O, Degrell P, Berman E. Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2015; 108: 428-36.
Perl L, Bental T, Assali A, et al. Impact of female sex on long-term acute coronary syndrome outcomes. Coron Artery Dis 2015; 26: 11-6.
Champney KP, Frederick PD, Bueno H, et al. The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart 2009; 95: 895-9.
Krumholz HM, Herrin J, Miller LE, et al. Improvements in door-to-balloon time in the United States, 2005 to 2010. Circulation 2011; 124: 1038-45.
Kammler J, Kypta A, Hofmann R, et al. TIMI 3 flow after primary angioplasty is an important predictor for outcome in patients with acute myocardial infarction. Clin Res Cardiol 2009; 98: 165-70.
Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of ‘no-reflow’ after percutaneous coronary intervention. Circulation 1994; 89: 2514-8.
Gąsior M, Pres D, Gierlotka M. Factors affecting microvascular flow in patients with myocardial infarction treated with percutaneous coronary interwention. Post Kardiol Interw 2007; 3: 121-7.
Kornowski R, Lansky AJ, Mintz GS, et al. Comparison of men versus women in cross-sectional area luminal narrowing, quantity of plaque, presence of calcium in plaque, and lumen location in coronary arteries by intravascular ultrasound in patients with stable angina pectoris. Am J Cardiol 1997; 79: 1601-5.
Watanabe Y, Sakakura K, Taniguchi Y, et al. Determinants of slow flow following stent implantation in intravascular ultrasound-guided primary percutaneous coronary intervention. Heart Vessels 2018; 33: 226-38.
Yi Xu, Ivan A, Arenas Stephen A, et al. Estrogen improves cardiac recovery after ischemia/reperfusion by decreasing tumor necrosis factor alpha. Cardiovasc Res 2006; 69: 836-44.
Prasad A, Stone GW, Stuckey TD, et al. Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction. J Am Coll Cardiol 2005; 45: 508-14.
Kandzari DE, Tcheng JE, Gersh BJ, et al. Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction. Am Heart J 2006; 151: 1288-95.
Petrina M, Goodman SG, Eagle KA. The 12-lead electrocardiogram as a predictive tool of mortality after acute myocardial infarction: current status in an era of revascularization and reperfusion. Am Heart J 2006; 152: 11-8.
Numasawa Y, Kohsaka S, Ueda I, et al. Incidence and predictors of bleeding complications after percutaneous coronary intervention. J Cardiol 2017; 69: 272-9.
Akhter N, Milford-Beland S, Roe MT, et al. Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). Am Heart J 2009; 157: 141-8.
Sadowski M, Janion-Sadowska A. The management of patients with cardiogenic shock. Med Stud 2017; 33: 55-62.
Kołodziej M, Kurzawski J, Janion-Sadowska A, et al. Mortality of women with ST-segment elevation myocardial infarction and cardiogenic shock – results from the PL-ACS registry. Med Stud 2016; 32: 157-63.
Nguyen JT, Berger AK, Duval S, et al. Gender disparity in cardiac procedures and medication use for acute myocardial infarction. Am Heart J 2008; 155: 862-8.
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-77.
Mehta RH, Ou FS, Peterson ED, et al. Clinical significance of postprocedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention. J Am Coll Cardiol Cardiovasc Interv 2009; 2: 56-64.
Lee CH, Wong HB, Tan HC, et al. Impact of reversibility of no reflow phenomenon on 30-day mortality following percutaneous revascularization for acute myocardial infarction-insights from a 1.328 patient registry. J Interv Cardiol 2005; 18: 261.
Reynolds HR, Srichai MB, Iqbal SN, et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation 2011; 124: 1414-25.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe