Sex Differences in Myocardial Salvage and Clinical Outcome in Patients With Acute Reperfused ST-Elevation Myocardial Infarction

Background— There is conflicting evidence regarding sex-based differences in myocardial salvage and clinical outcome in patients after ST-elevation myocardial infarction (STEMI). The aim of this study was to investigate whether there are sex-associated differences in infarct characteristics (myocardial salvage, infarct size, microvascular obstruction) and clinical outcome in STEMI patients who are reperfused by primary angioplasty. Methods and Results— In this study, we included 96 women and 239 men with STEMI undergoing primary angioplasty <12 hours after symptom onset. T2-weighted and contrast-enhanced cardiac MRI was used to assess myocardial salvage, infarct size, and microvascular obstruction. The primary clinical end point was mortality within 6 months after the index event. The amount of myocardium at risk and final infarct size did not differ significantly between women and men. Consequently, myocardial salvage was similar between groups ( P =0.36). Women had a higher in-hospital (3% versus 10%; P =0.03) and 30-day (5% versus 11%; P =0.05) mortality rate than did men. Six months after infarction, no significant sex differences in survival were obvious (11% versus 7%; P =0.21). After adjustment for baseline differences (age, diabetes, hypertension), female sex was not an independent predictor of mortality and major adverse cardiac events. Conclusions— The efficacy of primary percutaneous coronary intervention (myocardial salvage) in patients with STEMI is not sex dependent. Although women STEMI patients had worse unadjusted in-hospital and 30-day clinical outcomes than did men, multivariate analysis revealed that the observed sex-based differences in early death after STEMI were likely related to differences in baseline risk and clinical characteristics.