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

Zuzana Motovska; Ota Hlinomaz; Michael Aschermann; Jiri Jarkovsky; Michael Želízko; Petr Kala; Ladislav Groch; Michal Svoboda; Milan Hromadka; Petr Widimsky

doi:10.3389/fcvm.2022.953567

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

Front Cardiovasc Med. 2023 Jan 4:9:953567. doi: 10.3389/fcvm.2022.953567. eCollection 2022.

Authors

Affiliations

¹ Cardiocentre, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia.
² Department of Cardioangiology, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.
³ Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czechia.
⁴ Institute of Biostatistics and Analyses Ltd., Faculty of Medicine, Masaryk University, Brno, Czechia.
⁵ Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czechia.
⁶ Department of Internal and Cardiology, Faculty of Medicine, Masaryk University and University Hospital Brno-Bohunice, Brno, Czechia.
⁷ Department of Cardiology, Charles University, University Hospital in Pilsen, Pilsen, Czechia.

Abstract

Background: Sex- and gender-associated differences determine the disease response to treatment.

Aim: The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women.

Methods and results: 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%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 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], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17-0.91], p = 0.029).

Conclusion: 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.

Keywords: mortality; myocardial infarction; outcome; primary PCI; therapy management; trends; women.