Sex‐specific treatment effects after primary percutaneous intervention: a study on coronary blood flow and delay to hospital presentation

Scientific paper - Original scientific paper

• Author: Edina Cenko
• Author: Mihaela van der Schaar
• Author: Jinsung Yoon
• Author: Sasko Kedev
• Author: Marija Valvukis
• Author: Zorana Vasiljevic
• Author: Milika Ašanin
• Author: Davor Miličić
• Author: Olivia Manfrini
• Author: Lina Badimon
• Author: Raffaele Bugiardini
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Background: We hypothesized that female sex is a treatment effect modifier of blood flow and related 30-day mortality after
primary percutaneous coronary intervention (PCI) for ST-segment–elevation myocardial infarction and that the magnitude of the
effect on outcomes differs depending on delay to hospital presentation. -----
Methods and Results: We identified 2596 patients enrolled in the ISACS-TC (International Survey of Acute Coronary Syndromes
in Transitional Countries) registry from 2010 to 2016. Primary outcome was the occurrence of 30-day mortality. Key secondary
outcome was the rate of suboptimal post-PCI Thrombolysis in Myocardial Infarction (TIMI; flow grade 0–2). Multivariate logistic
regression and inverse probability of treatment weighted models were adjusted for baseline clinical covariates. We characterized
patient outcomes associated with a delay from symptom onset to hospital presentation of ≤120 minutes. In multivariable
regression models, female sex was associated with postprocedural TIMI flow grade 0 to 2 (odds ratio [OR], 1.68; 95% CI, 1.15–
2.44) and higher mortality (OR, 1.72; 95% CI, 1.02–2.90). Using inverse probability of treatment weighting, 30-day mortality was
higher in women compared with men (4.8% versus 2.5%; OR, 2.00; 95% CI, 1.27–3.15). Likewise, we found a significant sex
difference in post-PCI TIMI flow grade 0 to 2 (8.8% versus 5.0%; OR, 1.83; 95% CI, 1.31–2.56). The sex gap in mortality was no
longer significant for patients having hospital presentation of ≤120 minutes (OR, 1.28; 95% CI, 0.35–4.69). Sex difference in post-
PCI TIMI flow grade was consistent regardless of time to hospital presentation. -----
Conclusions: Delay to hospital presentation and suboptimal post-PCI TIMI flow grade are variables independently associated with
excess mortality in women, suggesting complementary mechanisms of reduced survival.

• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Journal of the American Heart Association
• Numbering: vol. 8, no. 4
• p-ISSN: 2047-9980
• DOI: https://doi.org/10.1161/JAHA.118.011190
• URN:NBN: urn:nbn:hr:105:826747
• Publication: 2019-02-19
• Document URL: http://doi.org/10.1161/JAHA.118.011190
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 10:27:44