Primary PCI in women with STEMI

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1 Primary PCI in women with STEMI Petr Widimský Cardiocenter Vinohrady Charles University Prague, CZ Cardiocenter, Third Faculty of Medicine, Charles University Prague

2 A case from 1994: dead female STEMI patient after technically perfect P-PCI A 69 years old lady (56 kg) with first inferior STEMI Technically ideal P-PCI of RCA Reperfusion after 2 hours from symptom onset Received bolus units heparin (our standard dose that time, but it was actually 179 U / kg!!!) Died from intracerebral bleeding next day. Cardiocenter, Third Faculty of Medicine, Charles University Prague

3 6746 consecutive STEMI pts (P-PCI )

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9 8,073 consecutive ppci-treated STEMI pts / 4 years In-hospital mortality rates for TIMI risk scores in women and men were compared. Females: older, more comorbidities, longer ischaemic times. In-hospital mortality 10.1% women vs. 4.9% men (OR 2.2; 95% CI: , p<0.001). After adjusting for TIMI risk score mortality remained higher in women (OR 1.47, 95% CI: , p=0.002). TIMI risk score predicted in-hospital mortality slightly better in men. Cardiocenter, Third Faculty of Medicine, Charles University Prague

10 Thrombolysis In Myocardial Infarction (TIMI) risk score for STEMI (0-14 points) 3 points for admission systolic BP <100 mmhg 3 points for age 75, 2 points for age 65-74, 2 points for admission Killip class >I 2 points for admission HR >100 beats/min 1 point for anterior infarction or LBBB 1 point for time to reperfusion therapy >4 hours 1 point for history of angina, diabetes or hypertension 1 point for admission weight <67 kg The risk is based on hemodynamics and age. Cardiocenter, Third Faculty of Medicine, Charles University Prague Other factors are not important.

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14 Impaired myocardial perfusion (worse MBG) following PCI for AMI is an independent predictor of early and late mortality in women but not in men. These findings imply an enhanced survival benefit from restoring myocardial perfusion for women during primary angioplasty. Am J Cardiol 2013; 112: Cardiocenter, Third Faculty of Medicine, Charles University Prague

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20 Conclusion: Long-distance transportation of women with STEMI from a community hospital to a tertiary PCI centre is a significantly more effective treatment strategy than on-site TL. Gender did not determine survival in patients transported for ppci. Cardiocenter, Third Faculty of Medicine, Charles University Prague

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23 Summary Females with STEMI have worse outcomes than males However, this is caused by differences in baseline characteristics (mainly age) Bleeding risk is greater in females and thus antithrombotic therapy must be tailored to body weight and renal function even more carefully in women Cardiocenter, Third Faculty of Medicine, Charles University Prague

24 Can we do something better for our female STEMI patients? Yes: do not kill them by too aggressive (or unadjusted) antithrombotic therapy! Cardiocenter, Third Faculty of Medicine, Charles University Prague