SEX-RELATED DIFFERENCES IN PATIENTS UNDERGOING DIRECT ANGIOPLASTY FORACUTE MYOCARDIAL-INFARCTION

Important sex-related differences have been recognized in several coro nary artery disease presentation and treatment subsets. Little data ex ist describing the relative findings and outcome in women versus men w ho received direct percutaneous transluminal coronary angioplasty for acute myocardial infarction. We studied 670 such patients of whom 464 (69%) were men and 206 were women. The women were significantly older (67 +/- 11 years vs 61 +/- 11, p < 0.001) but had undergone less prior coronary artery bypass graft surgery (6% vs 12%, p = 0.02), whereas p rior myocardial infarction (17% women vs 22% men) and coronary artery disease distribution were not significantly different. Forty-one perce nt of women and 43% of men had single-vessel disease (p = NS). Both wo men and men had 1.5 lesions/patient dilated acutely, with similar succ ess rates (95% women, 91% men; p = 0.08). Mean ejection fractions were similar (48% in both groups), and a similar percentage in each group had an ejection fraction <30% (10% women vs 13% men). Over a mean foll ow-up period of 86 weeks, the need for repeat catheterization was freq uent and was similar in both groups (44% women, 47% men; p = NS), wher eas documented restenosis was less common in women (20% vs 28% of pati ents, p < 0.05). The need for coronary artery bypass grafting was simi lar (15% women, 17% men; p = NS), as was the need for repeat percutane ous transluminal coronary angioplasty in the infarct vessel (14% women , 18% men; p = NS) and overall mortality (7% women, 9% men; p = NS). W e concluded that other than older age, the clinical features of the wo men initially seen for direct percutaneous transluminal coronary angio plasty for acute myocardial infarction are very similar to those of me n. In spite of this age difference, percutaneous transluminal coronary angioplasty success and outcomes are also very similar, other than a 29% lower incidence of documented restenosis in women.