Aim:
Previous studies demonstrate higher 30-day all-cause mortality and re-infarction amongst women with ST-elevation myocardial infarction (STEMI). This study examines if gender differences exist in cardiac hemodynamic parameters assessed during an acute STEMI.
Methods:
The clinical, angiographic and hemodynamic features of 470 consecutive patients undergoing emergency primary percutaneous coronary intervention for an acute STEMI were evaluated with respect to gender. Patients routinely underwent right heart catheterization using a Swan-Ganz catheter, during the emergency reperfusion therapy procedure. Infarct size was estimated by evaluating the peak creatinine kinase (CK) levels.
Results:
The 135 STEMI female patients were significantly older than males (69±13 vs. 60±12 years, P <0.001) so subsequent analyses were age-adjusted. The findings are summarized below (*p < 0.05, **p<0.001 compared with men). Multivariate logistic regression analysis revealed that pulmonary capillary wedge pressure (PCWP) was the strongest independent predictor of 30-day death and re-infarction (Odds Ratio for PCWP = 1.06 (95% CI = 1.01 - 1.12, p = 0.019).
Conclusion:
Women with an acute STEMI have a higher 30-day cardiac event rate despite similar extent of coronary artery disease, infarct size and site. However they do have higher left ventricular filling pressures, which is consistent with their poorer outcomes. The mechanism/s of this hemodynamic difference requires further investigation.
Clinical and Hemodynamic Features of STEMI patients (Expressed as Mean ± SD or frequency data)
Men (n = 335)
Women (n =135)
Acute Anterior STEMI on ECG
128 (41%)
53 (40%)
Peak Creatine Kinase
2309±5894 IU
1455±1797 IU
Multi-vessel disease on angiography
168 (51%)
61 (49%)
Initial Heart Rate
80±22 bpm
79±25 bpm
Initial systolic blood pressure
137±29 mmHg
145±99 mmHg
Pulmonary capillary wedge pressure
16±7 mmHg
20±7 mmHg*
Arterial oxygen saturation
97±4.5%
97±2.9%
Mixed venous oxygen saturation
70±9%
67±10%
30 Day All cause Mortality/Re-Infarction
14 (4%)
15 (11%)*