Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: Results from an individual patient-level pooled analysis of 10 randomized trials

Ioanna Kosmidou, Björn Redfors, Harry P. Selker, Holger Thiele, Manesh R. Patel, James E. Udelson, E. Magnus Ohman, Ingo Eitel, Christopher B. Granger, Akiko Maehara, Ajay Kirtane, Philippe Genereux, Paul L. Jenkins, Ori Ben-Yehuda, Gary S. Mintz, Gregg W. Stone

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Aim Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. Methods and results We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P>0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. Conclusions In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.

Original languageEnglish (US)
Pages (from-to)1656-1663
Number of pages8
JournalEuropean Heart Journal
Volume38
Issue number21
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Percutaneous Coronary Intervention
Left Ventricular Function
Hospitalization
Heart Failure
Stroke Volume
Sex Characteristics
Infarction
Mortality
Myocardial Infarction
Technetium Tc 99m Sestamibi
ST Elevation Myocardial Infarction
Single-Photon Emission-Computed Tomography
Reperfusion
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kosmidou, Ioanna ; Redfors, Björn ; Selker, Harry P. ; Thiele, Holger ; Patel, Manesh R. ; Udelson, James E. ; Magnus Ohman, E. ; Eitel, Ingo ; Granger, Christopher B. ; Maehara, Akiko ; Kirtane, Ajay ; Genereux, Philippe ; Jenkins, Paul L. ; Ben-Yehuda, Ori ; Mintz, Gary S. ; Stone, Gregg W. / Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction : Results from an individual patient-level pooled analysis of 10 randomized trials. In: European Heart Journal. 2017 ; Vol. 38, No. 21. pp. 1656-1663.
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title = "Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: Results from an individual patient-level pooled analysis of 10 randomized trials",
abstract = "Aim Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. Methods and results We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3{\%}) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P>0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. Conclusions In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.",
author = "Ioanna Kosmidou and Bj{\"o}rn Redfors and Selker, {Harry P.} and Holger Thiele and Patel, {Manesh R.} and Udelson, {James E.} and {Magnus Ohman}, E. and Ingo Eitel and Granger, {Christopher B.} and Akiko Maehara and Ajay Kirtane and Philippe Genereux and Jenkins, {Paul L.} and Ori Ben-Yehuda and Mintz, {Gary S.} and Stone, {Gregg W.}",
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Kosmidou, I, Redfors, B, Selker, HP, Thiele, H, Patel, MR, Udelson, JE, Magnus Ohman, E, Eitel, I, Granger, CB, Maehara, A, Kirtane, A, Genereux, P, Jenkins, PL, Ben-Yehuda, O, Mintz, GS & Stone, GW 2017, 'Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: Results from an individual patient-level pooled analysis of 10 randomized trials', European Heart Journal, vol. 38, no. 21, pp. 1656-1663. https://doi.org/10.1093/eurheartj/ehx159

Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction : Results from an individual patient-level pooled analysis of 10 randomized trials. / Kosmidou, Ioanna; Redfors, Björn; Selker, Harry P.; Thiele, Holger; Patel, Manesh R.; Udelson, James E.; Magnus Ohman, E.; Eitel, Ingo; Granger, Christopher B.; Maehara, Akiko; Kirtane, Ajay; Genereux, Philippe; Jenkins, Paul L.; Ben-Yehuda, Ori; Mintz, Gary S.; Stone, Gregg W.

In: European Heart Journal, Vol. 38, No. 21, 01.06.2017, p. 1656-1663.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

T2 - Results from an individual patient-level pooled analysis of 10 randomized trials

AU - Kosmidou, Ioanna

AU - Redfors, Björn

AU - Selker, Harry P.

AU - Thiele, Holger

AU - Patel, Manesh R.

AU - Udelson, James E.

AU - Magnus Ohman, E.

AU - Eitel, Ingo

AU - Granger, Christopher B.

AU - Maehara, Akiko

AU - Kirtane, Ajay

AU - Genereux, Philippe

AU - Jenkins, Paul L.

AU - Ben-Yehuda, Ori

AU - Mintz, Gary S.

AU - Stone, Gregg W.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Aim Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. Methods and results We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P>0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. Conclusions In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.

AB - Aim Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown. Methods and results We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P>0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization. Conclusions In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.

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U2 - 10.1093/eurheartj/ehx159

DO - 10.1093/eurheartj/ehx159

M3 - Article

C2 - 28407050

AN - SCOPUS:85020915980

VL - 38

SP - 1656

EP - 1663

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

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