Short and medium-term outcome differences in women and men after primary percutaneous transluminal mechanical revascularization for acute myocardial infarction

Women presenting with acute myocardial infarction (AMI) have a higher morta lity with conventional medical and thrombolytic therapy when compared with men. The outcome after primary percutaneous transluminal mechanical revascu larization has not yet been fully investigated. This study was performed to compare the characteristics and the short- and medium-term outcomes of wom en and men with AMI treated with primary percutaneous revascularization. A total of 182 consecutive patients (62 women and 120 men) were included. Bas eline clinical characteristics were similar except that women were older th an men, presented more often in cardiogenic shock, and had smaller referenc e vessel diameters. Stents and abciximab were used equally, but abciximab w as stopped more often in women before completion of the 12-hour infusion be cause of higher bleeding rates. Acute procedural success rates were similar (92% and 97%) but mortality was much higher in women, both at 30-day follo w-up (10% vs 0.9%; p <0.05) and during a mean follow-up of 6.9 +/- 4.1 mont hs (15% vs 4.4%; p <0.05). Women also experienced more unfavorable cardiova scular events (recurrent unstable angina or AMI, target vessel revasculariz ation) than men. However, after control for baseline clinical differences i n a multivariate analysis, gender was not an independent predictor of survi val, whereas age, cardiogenic shock, and completion of a 12-hour abciximab infusion were. (C) 2000 by Excerpta Medico, Inc.