Predictors of In-hospital Mortality after Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction
-
Soraya Siabani
,
Maryam Babakhani
,
Nahid Salehi
,
Mohammad Rouzbahani
,
Javad Azimivaghar
,
Sousan Mahmoudi
,
Yousef Rahmani
,
Hossein Siabani
Abstract
Introduction: Treatment of myocardial infarction (MI) has been successfully developed, especially after introducing primary percutaneous coronary intervention (PPCI) as it nowadays is the recommended treatment for ST-segment elevation myocardial infarction (STEMI).
Objective: This study aimed to evaluate the in-hospital mortality of STEMI patients treated with PPCI according to gender and other likely risk factors.
Methods: This cross-sectional study presents a part of the results of a single-center registry in Imam Ali cardiovascular center affiliated to Kermanshah University of medical science (KUMS). From June 2016 to December 2017, 731 consecutive patients undergoing PPCI registered. Data were collected using a case report form developed by European Observational Registry Program (EORP). The relationship between in-hospital mortality and predicting variables was assessed using the Chi-square test, t-test, and univariate and multivariate logistic regression models (Forward LR).
Results: Totally, 155 patients (approximately 21%) were female. The mean age of women and men was 65.2 and 57.5, respectively (p=0.001). There were differences between women and men in hypertension (58.1% vs. 30.4%, respectively, p=0.001), diabetes mellitus (26.5% vs. 14.9%; p=0.001), hypercholesterolemia (37.4% vs. 18.6%; p=0.001), and history of prior congestive heart failure (5.2% vs. 2.0%; p=0.016). Although more men were current smokers (58.7% (men) vs. 15.5% (women); p=0.001). Women had a significantly greater incidence of multi-vessel disease, thrombolysis in myocardial infarction (TIMI) flow grade of 0/1 before PPCI, and longer symptom-to-balloon time. In-hospital mortality was higher in women than in men (5.2% vs. 1.9%; p=0.024). Multivariate analysis identified age ≥ 60 years, Killip class≥ II, and post-procedural TIMI flow grade < 3, but not female sex, as independent predictors of in-hospital mortality.
Conclusion: In-hospital mortality after PPCI in women was higher than men, though this difference was likely due to the severe clinical profile in women. Also, female gender was not identified as an independent predictor of death.
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2. Barbosa RR, da Silva VR, Serpa RG, Cesar FB, Mauro VF, Bayerl DMdR, et al. Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction. Rev Bras Cardiol Invasiva. 2015;23(2):96-101.
3. Cheng CI, Yeh KH, Chang HW, Yu TH, Chen YH, Chai HT, et al. Comparison of baseline characteristics, clinical features, angiographic results, and early outcomes in men vs women with acute myocardial infarction undergoing primary coronary intervention. Chest. 2004;126(1):47-53.
4. Bennett SK, Redberg RF. Acute coronary syndromes in women: Is treatment different? should it be? Curr Cardiol Rep. 2004;6(4):243-52.
5. Hurtado-Martínez J, Pinar-Bermúdez E, Teruel-Carrillo F, Gimeno-Blanes JR, Lacunza-Ruiz J, Valdesuso R, et al. In-Hospital and Long-Term Mortality in Women With Acute Myocardial Infarction Treated by Primary Angioplasty. Rev Esp Cardiol. 2006;59(11):1113-22.
6. Mrdovic I, Savic L, Asanin M, Cvetinovic N, Brdar N, Djuricic N, et al. Sex-Related Analysis of Short- and Long-term Clinical Outcomes and Bleeding Among Patients Treated With Primary Percutaneous Coronary Intervention: An Evaluation of the RISK-PCI Data. Can J Cardiol. 2013;29(9):1097-103.
7. Valente S, Lazzeri C, Chiostri M, Giglioli C, Zucchini M, Grossi F, et al. Gender-related difference in ST-elevation myocardial infarction treated with primary angioplasty: a single-centre 6-year registry. Eur J Prev Cardiol. 2011;19(2):233-40.
8. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485-510.
9. Mak K, Kark J, Chia K, Sim L, Foong B, Ding Z, et al. Ethnic variations in female vulnerability after an acute coronary event. Heart. 2004;90(6):621-6.
10. Valle JA, Kaltenbach LA, Bradley SM, Yeh RW, Rao SV, Gurm HS, et al. Variation in the adoption of transradial access for ST-segment elevation myocardial infarction: insights from the NCDR CathPCI Registry. JACC Cardiovasc Interv. 2017;10(22):2242-54.
11. Krumholz HM, Herrin J, Miller LE, Drye EE, Ling SM, Han LF, et al. Improvements in door-to-balloon time in the United States, 2005 to 2010. Circulation. 2011;124(9):1038-45.
12. Huded CP, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett TC, et al. 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. J Am Coll Cardiol. 2018;71(19):2122-32.
13. De Luca G, Cassetti E, Marino P. Percutaneous coronary intervention–related time delay, patient's risk profile, and survival benefits of primary angioplasty vs lytic therapy in ST-segment elevation myocardial infarction. Am J Emerg Med. 2009;27(6):712-9.
14. van der Meer MG, Nathoe HM, van der Graaf Y, Doevendans PA, Appelman Y. Worse outcome in women with STEMI: a systematic review of prognostic studies. Eur J Clin Invest. 2015;45(2):226-35.
15. Fang J, Alderman MH. Gender differences of revascularization in patients with acute myocardial infarction. Am J Cardiol. 2006;97(12):1722-6.
16. Radovanovic D, Erne P, Urban P, Bertel O, Rickli H, Gaspoz J-M. Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20 290 patients from the AMIS Plus Registry. Heart. 2007;93(11):1369-75.
17. Singh M, Rihal CS, Gersh BJ, Roger VL, Bell MR, Lennon RJ, et al. Mortality differences between men and women after percutaneous coronary interventions: a 25-year, single-center experience. J Am Coll Cardiol. 2008;51(24):2313-20.
18. Hailer B, Naber C, Koslowski B, van Leeuwen P, Schafer H, Budde T, et al. Gender-related differences in patients with ST-elevation myocardial infarction: results from the registry study of the ST elevation myocardial infarction network Essen. Clin Cardiol. 2011;34(5):294-301.
19. Thygesen K, Alpert J, Jaffe A. Erratum: Third universal definition of myocardial infarction (Journal of the American College of Cardiology (2012) 60 (158-98) DOI: 10.1016/j.jacc.2012. 08.001). J Am Coll Cardiol. 2013;61(5):598.
20. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on behalf of the 2004 writing committee. Circulation. 2008;117(2):296-329.
21. Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G, et al. Sex Differences in Outcomes After STEMI. JAMA Intern Med. 2018; 178(5): 632–9.
22. Gebhard C, Gebhard CE, Stahli BE, Maafi F, Bertrand MJ, Wildi K, et al. Weather and risk of ST-elevation myocardial infarction revisited: Impact on young women. PLoS One. 2018;13(4):e0195602.
23. Williams J, Adams M, Klopfenstein H. Estrogen modulates responses of atherosclerotic coronary arteries: Circulation 1990 81/5 (1680–1687). Maturitas. 1991;13(1):84-5.
24. Birkemeyer R, Schneider H, Rillig A, Ebeling J, Akin I, Kische S, et al. Do gender differences in primary PCI mortality represent a different adherence to guideline recommended therapy? a multicenter observation. BMC Cardiovasc Disord. 2014;14:71.
25. Benamer H, Tafflet M, Bataille S, Escolano S, Livarek B, Fourchard V, et al. Female gender is an independent predictor of in-hospital mortality after STEMI in the era of primary PCI: insights from the greater Paris area PCI Registry. EuroIntervention. 2011;6(9):1073-9.
26. Wijnbergen I, Tijssen J, van 't Veer M, Michels R, Pijls NHJ. Gender differences in long-term outcome after primary percutaneous intervention for ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv. 2013;82(3):379-84.
27. Velders MA, Boden H, van Boven AJ, van der Hoeven BL, Heestermans AACM, Cannegieter SC, et al. Influence of Gender on Ischemic Times and Outcomes After ST-Elevation Myocardial Infarction. Am J Cardiol. 2013;111(3):312-8.
28. Wei J, Mehta PK, Grey E, Garberich RF, Hauser R, Bairey Merz CN, et al. Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol. Am Heart J. 2017;191:30-6.
29. Zhang B, Jiang DM, Sun YJ, Ren LN, Zhang ZH, Gao Y, et al. [The role of gender difference on the prognosis of ST-segment elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention]. Zhonghua Liu Xing Bing Xue Za Zhi. 2012;33(1):92-8.
30. Akhter N, Milford-Beland S, Roe MT, Piana RN, Kao J, Shroff A. 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(1):141-8.
31. Anand SS, Xie CC, Mehta S, Franzosi MG, Joyner C, Chrolavicius S, et al. Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. J Am Coll Cardiol. 2005;46(10):1845-51.
32. Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, et al. Gender disparities in the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) national quality improvement initiative. J Am Coll Cardiol. 2005;45(6):832-7.
33. Hochholzer W, Wiviott SD, Antman EM, Contant CF, Guo J, Giugliano RP, et al. Predictors of bleeding and time dependence of association of bleeding with mortality: insights from the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel—Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38). Circulation. 2011;123(23):2681-9.
34. Mikhail GW. Coronary revascularisation in women. Heart. 2006;92 Suppl 3(suppl 3):iii19-23.
35. Zhang Q, Qiu J-P, Zhang R-Y, Li Y-g, He B, Jin H-G, et al. Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing sirolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registry. Chinese Med J. 2010;123(7):782-8.
36. Sadowski M, Janion-Sadowska A, Gasior M, Gierlotka M, Janion M, Polonski L. Gender-related benefit of transport to primary angioplasty: is it equal? Cardiol J. 2011;18(3):254-60.
37. Milcent C, Dormont B, Durand-Zaleski I, Steg PG. Gender differences in hospital mortality and use of percutaneous coronary intervention in acute myocardial infarction: microsimulation analysis of the 1999 nationwide French hospitals database. Circulation. 2007;115(7):833-9.
38. Kanic V, Vollrath M, Naji FH, Sinkovic A. Gender Related Survival Differences in ST-Elevation Myocardial Infarction Patients Treated with Primary PCI. Int J Med Sci. 2016;13(6):440-4.
39. De Luca G, Gibson CM, Gyöngyösi M, Zeymer U, Dudek D, Arntz H-R, et al. Gender-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb–IIIa inhibitors: insights from the EGYPT cooperation. J Thromb Thrombolysis. 2010;30(3):342-6.
40. Pu J, Shan P, Ding S, Qiao Z, Jiang L, Song W, et al. Gender differences in epicardial and tissue-level reperfusion in patients undergoing primary angioplasty for acute myocardial infarction. Atherosclerosis. 2011;215(1):203-8.
2. Barbosa RR, da Silva VR, Serpa RG, Cesar FB, Mauro VF, Bayerl DMdR, et al. Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction. Rev Bras Cardiol Invasiva. 2015;23(2):96-101.
3. Cheng CI, Yeh KH, Chang HW, Yu TH, Chen YH, Chai HT, et al. Comparison of baseline characteristics, clinical features, angiographic results, and early outcomes in men vs women with acute myocardial infarction undergoing primary coronary intervention. Chest. 2004;126(1):47-53.
4. Bennett SK, Redberg RF. Acute coronary syndromes in women: Is treatment different? should it be? Curr Cardiol Rep. 2004;6(4):243-52.
5. Hurtado-Martínez J, Pinar-Bermúdez E, Teruel-Carrillo F, Gimeno-Blanes JR, Lacunza-Ruiz J, Valdesuso R, et al. In-Hospital and Long-Term Mortality in Women With Acute Myocardial Infarction Treated by Primary Angioplasty. Rev Esp Cardiol. 2006;59(11):1113-22.
6. Mrdovic I, Savic L, Asanin M, Cvetinovic N, Brdar N, Djuricic N, et al. Sex-Related Analysis of Short- and Long-term Clinical Outcomes and Bleeding Among Patients Treated With Primary Percutaneous Coronary Intervention: An Evaluation of the RISK-PCI Data. Can J Cardiol. 2013;29(9):1097-103.
7. Valente S, Lazzeri C, Chiostri M, Giglioli C, Zucchini M, Grossi F, et al. Gender-related difference in ST-elevation myocardial infarction treated with primary angioplasty: a single-centre 6-year registry. Eur J Prev Cardiol. 2011;19(2):233-40.
8. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485-510.
9. Mak K, Kark J, Chia K, Sim L, Foong B, Ding Z, et al. Ethnic variations in female vulnerability after an acute coronary event. Heart. 2004;90(6):621-6.
10. Valle JA, Kaltenbach LA, Bradley SM, Yeh RW, Rao SV, Gurm HS, et al. Variation in the adoption of transradial access for ST-segment elevation myocardial infarction: insights from the NCDR CathPCI Registry. JACC Cardiovasc Interv. 2017;10(22):2242-54.
11. Krumholz HM, Herrin J, Miller LE, Drye EE, Ling SM, Han LF, et al. Improvements in door-to-balloon time in the United States, 2005 to 2010. Circulation. 2011;124(9):1038-45.
12. Huded CP, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett TC, et al. 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. J Am Coll Cardiol. 2018;71(19):2122-32.
13. De Luca G, Cassetti E, Marino P. Percutaneous coronary intervention–related time delay, patient's risk profile, and survival benefits of primary angioplasty vs lytic therapy in ST-segment elevation myocardial infarction. Am J Emerg Med. 2009;27(6):712-9.
14. van der Meer MG, Nathoe HM, van der Graaf Y, Doevendans PA, Appelman Y. Worse outcome in women with STEMI: a systematic review of prognostic studies. Eur J Clin Invest. 2015;45(2):226-35.
15. Fang J, Alderman MH. Gender differences of revascularization in patients with acute myocardial infarction. Am J Cardiol. 2006;97(12):1722-6.
16. Radovanovic D, Erne P, Urban P, Bertel O, Rickli H, Gaspoz J-M. Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20 290 patients from the AMIS Plus Registry. Heart. 2007;93(11):1369-75.
17. Singh M, Rihal CS, Gersh BJ, Roger VL, Bell MR, Lennon RJ, et al. Mortality differences between men and women after percutaneous coronary interventions: a 25-year, single-center experience. J Am Coll Cardiol. 2008;51(24):2313-20.
18. Hailer B, Naber C, Koslowski B, van Leeuwen P, Schafer H, Budde T, et al. Gender-related differences in patients with ST-elevation myocardial infarction: results from the registry study of the ST elevation myocardial infarction network Essen. Clin Cardiol. 2011;34(5):294-301.
19. Thygesen K, Alpert J, Jaffe A. Erratum: Third universal definition of myocardial infarction (Journal of the American College of Cardiology (2012) 60 (158-98) DOI: 10.1016/j.jacc.2012. 08.001). J Am Coll Cardiol. 2013;61(5):598.
20. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on behalf of the 2004 writing committee. Circulation. 2008;117(2):296-329.
21. Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G, et al. Sex Differences in Outcomes After STEMI. JAMA Intern Med. 2018; 178(5): 632–9.
22. Gebhard C, Gebhard CE, Stahli BE, Maafi F, Bertrand MJ, Wildi K, et al. Weather and risk of ST-elevation myocardial infarction revisited: Impact on young women. PLoS One. 2018;13(4):e0195602.
23. Williams J, Adams M, Klopfenstein H. Estrogen modulates responses of atherosclerotic coronary arteries: Circulation 1990 81/5 (1680–1687). Maturitas. 1991;13(1):84-5.
24. Birkemeyer R, Schneider H, Rillig A, Ebeling J, Akin I, Kische S, et al. Do gender differences in primary PCI mortality represent a different adherence to guideline recommended therapy? a multicenter observation. BMC Cardiovasc Disord. 2014;14:71.
25. Benamer H, Tafflet M, Bataille S, Escolano S, Livarek B, Fourchard V, et al. Female gender is an independent predictor of in-hospital mortality after STEMI in the era of primary PCI: insights from the greater Paris area PCI Registry. EuroIntervention. 2011;6(9):1073-9.
26. Wijnbergen I, Tijssen J, van 't Veer M, Michels R, Pijls NHJ. Gender differences in long-term outcome after primary percutaneous intervention for ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv. 2013;82(3):379-84.
27. Velders MA, Boden H, van Boven AJ, van der Hoeven BL, Heestermans AACM, Cannegieter SC, et al. Influence of Gender on Ischemic Times and Outcomes After ST-Elevation Myocardial Infarction. Am J Cardiol. 2013;111(3):312-8.
28. Wei J, Mehta PK, Grey E, Garberich RF, Hauser R, Bairey Merz CN, et al. Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol. Am Heart J. 2017;191:30-6.
29. Zhang B, Jiang DM, Sun YJ, Ren LN, Zhang ZH, Gao Y, et al. [The role of gender difference on the prognosis of ST-segment elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention]. Zhonghua Liu Xing Bing Xue Za Zhi. 2012;33(1):92-8.
30. Akhter N, Milford-Beland S, Roe MT, Piana RN, Kao J, Shroff A. 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(1):141-8.
31. Anand SS, Xie CC, Mehta S, Franzosi MG, Joyner C, Chrolavicius S, et al. Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. J Am Coll Cardiol. 2005;46(10):1845-51.
32. Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, et al. Gender disparities in the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) national quality improvement initiative. J Am Coll Cardiol. 2005;45(6):832-7.
33. Hochholzer W, Wiviott SD, Antman EM, Contant CF, Guo J, Giugliano RP, et al. Predictors of bleeding and time dependence of association of bleeding with mortality: insights from the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel—Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38). Circulation. 2011;123(23):2681-9.
34. Mikhail GW. Coronary revascularisation in women. Heart. 2006;92 Suppl 3(suppl 3):iii19-23.
35. Zhang Q, Qiu J-P, Zhang R-Y, Li Y-g, He B, Jin H-G, et al. Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing sirolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registry. Chinese Med J. 2010;123(7):782-8.
36. Sadowski M, Janion-Sadowska A, Gasior M, Gierlotka M, Janion M, Polonski L. Gender-related benefit of transport to primary angioplasty: is it equal? Cardiol J. 2011;18(3):254-60.
37. Milcent C, Dormont B, Durand-Zaleski I, Steg PG. Gender differences in hospital mortality and use of percutaneous coronary intervention in acute myocardial infarction: microsimulation analysis of the 1999 nationwide French hospitals database. Circulation. 2007;115(7):833-9.
38. Kanic V, Vollrath M, Naji FH, Sinkovic A. Gender Related Survival Differences in ST-Elevation Myocardial Infarction Patients Treated with Primary PCI. Int J Med Sci. 2016;13(6):440-4.
39. De Luca G, Gibson CM, Gyöngyösi M, Zeymer U, Dudek D, Arntz H-R, et al. Gender-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb–IIIa inhibitors: insights from the EGYPT cooperation. J Thromb Thrombolysis. 2010;30(3):342-6.
40. Pu J, Shan P, Ding S, Qiao Z, Jiang L, Song W, et al. Gender differences in epicardial and tissue-level reperfusion in patients undergoing primary angioplasty for acute myocardial infarction. Atherosclerosis. 2011;215(1):203-8.
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| Issue | Vol 4 No 3 (2020): Summer (July) | |
| Section | Original article | |
| Keywords | ||
| Iran Mortality Myocardial Infarction Percutaneous Coronary Intervention Registries Sex | ||
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How to Cite
1.
Siabani S, Babakhani M, Salehi N, Rouzbahani M, Azimivaghar J, Mahmoudi S, Rahmani Y, Siabani H. Predictors of In-hospital Mortality after Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction. Front Emerg Med. 2020;4(3):e76.
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