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CLINICAL RESEARCH: ACUTE CORONARY SYNDROMES

Gender and myocardial salvage after reperfusion treatment in acute myocardial infarction

Julinda Mehilli, MD^*,*, Gjin Ndrepepa, MD^*, Adnan Kastrati, MD^*, Stephan G. Nekolla, PhD, Christina Markwardt, MD^*, Hildegard Bollwein, MD, Jürgen Pache, MD^*, Stefan Martinoff, MD^*, Josef Dirschinger, MD, Markus Schwaiger, MD and Albert Schömig, MD

^* Deutsches Herzzentrum, Technischen Universität, Munich, Germany
1. Medizinische Klinik rechts der Isar, Technischen Universität, Munich, Germany
Nuklearmedizinische Klinik rechts der Isar, Technischen Universität, Munich, Germany

Manuscript received October 1, 2004; revised manuscript received November 16, 2004, accepted November 22, 2004.

^* Reprint requests and correspondence: Dr. Julinda Mehilli, Deutsches Herzzentrum, Lazarettstr. 36, 80636 München, Germany (Email: mehilli{at}dhm.mhn.de).

OBJECTIVES: The aim of this study was to investigate whether there are gender-associated differences in the amount of myocardial salvage after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).

BACKGROUND: Despite having a more adverse cardiovascular risk profile, women with AMI have similar or even better outcomes after primary PCI compared with men. The reasons for these findings are unclear.

METHODS: In this study we included 202 women and 561 men with AMI who underwent primary PCI in the setting of three randomized trials. The primary end point of the study was myocardial salvage index (proportion of initial perfusion defect salvaged by reperfusion therapy), obtained by paired scintigraphic studies performed 7 to 10 days apart.

RESULTS: The amount of myocardium at risk or initial perfusion defect (median [25th, 75th percentiles]) did not differ significantly between women and men (22.0% [12.0, 40.0] vs. 24.0% [14.0, 39.0] of the left ventricle [LV], p = 0.26). Final infarct size, measured in the follow-up scintigraphy, was significantly smaller in women than in men (6.0% [0.71, 18.7] vs. 10.0% [3.9, 21.8] of the LV, p = 0.001). Myocardial salvage index was 0.64 (0.35, 0.95) in women versus 0.50 (0.26, 0.77) in men (p < 0.001). After adjustment for baseline characteristics, female gender was an independent predictor of greater myocardial salvage after PCI (p = 0.002).

CONCLUSIONS: The efficacy of primary PCI in patients with AMI appears to be gender-dependent. Myocardial salvage achieved by primary PCI is greater in women than in men.

Abbreviations and Acronyms   AMI = acute myocardial infarction   LV = left ventricle   PCI = percutaneous coronary intervention   SPECT = single-photon emission computed tomography   STOPAMI = Stent Versus Thrombolysis for Occluded Coronary Arteries in Patients With Acute Myocardial Infarction trial   STOPAMI-3 = Stent or Percutaneous Transluminal Coronary Angioplasty for Occluded Coronary Arteries in Patients With Acute Myocardial Infarction Ineligible for Thrombolysis trial   Tc = technetium   TIMI = Thrombolysis In Myocardial Infarction

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