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 |
|
This article has been cited by other articles:
|
|
|
|
 
J. Mehilli, A. Kastrati, S. Schulz, S. Frungel, S. G. Nekolla, W. Moshage, F. Dotzer, K. Huber, J. Pache, J. Dirschinger, et al.
Abciximab in Patients With Acute ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention After Clopidogrel Loading: A Randomized Double-Blind Trial
Circulation,
April 14, 2009;
119(14):
1933 - 1940.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Elapsed Time in Emergency Medical Services for Patients With Cardiac Complaints: Are Some Patients at Greater Risk for Delay?
Circ Cardiovasc Qual Outcomes,
January 1, 2009;
2(1):
9 - 15.
|
|
|
|
|
|
|
M. Singh, C. S. Rihal, B. J. Gersh, V. L. Roger, M. R. Bell, R. J. Lennon, A. Lerman, and D. R. Holmes Jr
Mortality differences between men and women after percutaneous coronary interventions. A 25-year, single-center experience.
J. Am. Coll. Cardiol.,
June 17, 2008;
51(24):
2313 - 2320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Bell, E. R. Porrello, C. E. Huggins, S. B. Harrap, and L. M. D. Delbridge
The intrinsic resistance of female hearts to an ischemic insult is abrogated in primary cardiac hypertrophy
Am J Physiol Heart Circ Physiol,
April 1, 2008;
294(4):
H1514 - H1522.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Brown and R. L. Moore
Perspectives in innate and acquired cardioprotection: cardioprotection acquired through exercise
J Appl Physiol,
November 1, 2007;
103(5):
1894 - 1899.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Radovanovic, P. Erne, P. Urban, O. Bertel, H. Rickli, J.-M. Gaspoz, and on behalf of the AMIS Plus Investigators
Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20 290 patients from the AMIS Plus Registry
Heart,
November 1, 2007;
93(11):
1369 - 1375.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Murphy and C. Steenbergen
Gender-based differences in mechanisms of protection in myocardial ischemia-reperfusion injury
Cardiovasc Res,
August 1, 2007;
75(3):
478 - 486.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Chicco, M. S. Johnson, C. J. Armstrong, J. M. Lynch, R. T. Gardner, G. S. Fasen, C. P. Gillenwater, and R. L. Moore
Sex-specific and exercise-acquired cardioprotection is abolished by sarcolemmal KATP channel blockade in the rat heart
Am J Physiol Heart Circ Physiol,
May 1, 2007;
292(5):
H2432 - H2437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Johnson, R. L. Moore, and D. A. Brown
Sex differences in myocardial infarct size are abolished by sarcolemmal KATP channel blockade in rat
Am J Physiol Heart Circ Physiol,
June 1, 2006;
290(6):
H2644 - H2647.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
