Long-term prognosis after ST-elevation myocardial infarction in men and women stratified by age

Outcome following ST-elevation myocardial infarction (STEMI) is usually thought to be worse in women than in men, but some authors suggested that this difference may be caused by the difference in age and/or other clinical characteristics. The aim of this study was to analyze the impact of sex and age on long-term all-cause mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI).

we analyze 3079 patients included in the University Clinical Center of our country STEMI Register hospitalized between 1 December 2005 and 31 December 2016. Patients presenting with cardiogenic shock were excluded. The follow-up period was 8 years.

Out of 3079 patients, 2238 (72.6%) patients were men and 841 (27.2%) patients were women. The mean age of all analyzed patients was 60 (IQR 62, 69) years; women were older than men: 64 (IQR 57, 73) years vs 58 (IQR 50, 67) years, respectively, p<0.001. Also, compared with men, women were more likely to have previous coronary artery disease, diabetes, hypertension, hyperlipidemia, chronic kidney disease, heart failure at admission, post-procedural flow TIMI<3 and lower pre-discharge left ventricular ejection fraction (EF). Kaplan-Meier analysis showed a higher mortality in women than in men: 11.5% vs 7.5%, respectively, p<0.001; (Figure 1). Univariable Cox analysis also showed that female sex was a predictor for 8-year all-cause mortality (HR 1.58, 95%CI 1.21-2.08, p=0.025). After age stratification (≤65 years and >65 years) there was no difference in mortality between men and women, as shown in Figure 2. Cox regression multivariable analysis also confirmed that sex was not an independent predictor for 8-year mortality (HR 1.05, 85%CI 0.86-1.08, p=0.691). On the other hand, (older) age was an independent predictor for 8-year mortality (HR1.02; 95%CI 1.01-1.05, p<0.001). Other independent predictors were post-procedural flow TIMI<3 (HR 2.12; 95%CI 1.52-2.97, p<0.001); lower pre-discharge EF (HR 0.92; 95%CI 0,90-0,93; p<0.001), Killip class II and III at admission (HR 1.82; 95%CI 1.36-2.45; p=<0.001), chronic kidney disease (HR 1.42; 95%CI 1.12-2.03; p=0.015) and diabetes (HR 1.35, 95%CI 1,05-1.67, p=0.052).

Unadjusted eight-year mortality following STEMI was significantly higher in women as compared with men. After adjusting for age, there was no significant difference in eight-year mortality between men and women. In multivariable analysis age, but not sex, was independently associated with long-term mortality.