Background: Little is known regarding differences in left ventricular ejection fraction (LVEF) following anterior ST segment elevation myocardial infarction (STEMI), despite it being a major determinant of patients’ morbidity and mortality. We therefore sought to investigate the impact of gender on LVEF following primary percutaneous coronary intervention (PCI) for first anterior STEMI.
Methods: We used our single center registry of patients undergoing primary PCI for STEMI between January 2001 and September 2013. Procedural and angiographic results and clinical outcomes up to 2 years were collected and adjudicated for major cardiac adverse events. The presentation and clinical outcome of 789 patients with first anterior STEMI were analyzed and compared according to gender.
Results: Women were older than men and were more likely to have diabetes, hypertension and chronic renal failure. They presented to the emergency room (ER) later with a higher Killip class. More women had a LVEF <40% assessed by echocardiography during their hospital stay (61.6% and 48% respectively, p=0.002, median LVEF 35% (30%-45%) and 45% (35%-45% respectively, p=0.003). 30-day mortality did not differ between genders (4.9%vs3.7%). Women had increased 1 and 2-year mortality and recurrent MI (11.6%vs6.1%, 19%vs9%, 10.4%vs4.5%, 11.6%vs6.3% respectively). In a multivariate analysis adjusted for baseline differences, late ER arrival, multivessel disease and pre-PCI TIMI score were independent predictors of reduced LVEF, whereas female gender was not.
Conclusion: In women undergoing primary PCI for anterior STEMI LVEF is reduced, which may be attributed to late arrival at the ER. Hence, efforts should be focused on increasing women’s awareness of cardiac symptoms during the pre-hospital course of STEMI. Additionally, further studies are needed to investigate the post infarction management among women versus men, which might explain their higher rates of long-term mortality compared to men in contrast to similar mortality rates at 30-days.
