Sex differences in myocardial salvage and clinical outcome in patients with acute reperfused ST-elevation myocardial infarction: advances in cardiovascular imaging.
ABSTRACT 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.
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.
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.
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ABSTRACT: There is conflicting evidence on the impact of gender on reperfusion after primary coronary angioplasty (PPCI), and on left ventricular (LV) remodelling (LVR). In a cohort of patients with reperfused ST elevation myocardial infarction (STEMI), gender-related differences on myocardial reperfusion, and sex-related differences on LVR were assessed by using a comprehensive cardiac magnetic resonance (CMR) approach. In four tertiary referral centres, 283 (238 males and 45 females) consecutive STEMI patients, treated with PPCI within 12 h from symptoms onset underwent CMR 3 ± 2 days after STEMI and at 4-month follow-up. By CMR, the area at risk, infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) were assessed. Women were older than men (P = 0.014), more hypertensive (P < 0.001) and more frequently presented with pre-infarct angina (P = 0.018). An MSI extent was significantly higher (P = 0.013), IS was significantly smaller at both time points (acute P < 0.001, follow-up P < 0.001), and the MVO extent was significantly smaller (P < 0.001) in women. At multivariate analysis, Killip class and female sex were independently associated with a higher MSI (P = 0.02, P = 0.05, respectively). A similar incidence of LVR in both sexes was observed at follow-up (P = 0.808). The better reperfusion pattern observed in women by CMR in our population of reperfused STEMI suggests sex-based differences exist. No gender differences were observed with respect to incidence of LV remodelling at the follow-up mainly occurring in the subset of patients with a larger IS.European heart journal cardiovascular Imaging. 04/2012; 13(11):948-53.
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ABSTRACT: The myocardial microcirculation provides the vital pressure control and metabolic homeostasis for normal muscle function. Microvascular dysfunction is implicated in chronic cardiac disease and can signify higher risk, but its effect in acute myocardial infarction (AMI) can be profound. Modern management of AMI is focussed entirely on timely epicardial coronary patency, but as a result can leave microcirculatory devastation in its wake. The 'no-reflow' phenomenon occurs in up to 40 % of those successfully reperfused following an ST-elevation AMI (STEMI), and reflects significant microvessel injury that at its most severe involves both microvascular obstruction (MVO) and intramyocardial haemorrhage. Myocardial contrast echocardiography and cardiac magnetic resonance imaging have both led the field in establishing MVO as the prime determinant of adverse left ventricular (LV) remodeling, LV dysfunction, heart failure and increased mortality. These imaging techniques will be essential to support future research endeavours and shift focus to the maintenance of microvascular flow in AMI.Current Heart Failure Reports 08/2012;