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Open Access Research article

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

Ralf Birkemeyer1*, Henrik Schneider1, Andreas Rillig2, Juliane Ebeling1, Ibrahim Akin1, Stefan Kische1, Liliya Paranskaya1, Werner Jung3, Hueseyin Ince1 and Christoph A Nienaber1

Author Affiliations

1 Department of Cardiology, Heart Center Rostock, Medizinische Klinik I, Universitätsklinikum Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany

2 Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany

3 Department of Cardiology, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany

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BMC Cardiovascular Disorders 2014, 14:71  doi:10.1186/1471-2261-14-71

Published: 2 June 2014

Abstract

Background

It is uncertain whether gender differences in outcome after primary percutaneous coronary intervention (PCI) are only attributable to different baseline characteristics or additional factors.

Methods

Databases 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.

Results

Approximately 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.

Conclusion

Higher 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.

Keywords:
Primary PCI; Myocardial infarction network; Gender differences