Trends in outcomes of women with myocardial infarction undergoing primary angioplasty-Analysis of randomized trials

• Published in: Frontiers in cardiovascular medicine Vol. 9; p. 953567
• Main Authors: Motovska, Zuzana, Hlinomaz, Ota, Aschermann, Michael, Jarkovsky, Jiri, Želízko, Michael, Kala, Petr, Groch, Ladislav, Svoboda, Michal, Hromadka, Milan, Widimsky, Petr
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 04.01.2023
• Subjects: Cardiovascular Medicine; mortality; myocardial infarction; outcome; primary PCI; trends; women; therapy management; myocardial infarction; mortality; primary PCI; outcome; trends; women
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2022.953567

Sex- and gender-associated differences determine the disease response to treatment. The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03-3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0-2.23]), and also for an optimal procedural result (4.24 [2.12-8.49], < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17-0.91], = 0.029). The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.