Venetsanos D, et al. - This article was written with the objective to assess gender differences in outcomes in patients with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). In patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could be described in terms of older age and clustering of comorbidities.

Methods

• For this study, they conducted a prespecified gender investigation of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST-elevation myocardial Infarction to open the Coronary artery.
• In this study, they enrolled patients with STEMI and symptom duration <6 hours.
• They selected total 1862 patient between September 2011 and October 2013.
• Patients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor.

Results

• Women were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery.
• Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51).
• After adjustment, the difference was attenuated but remained statistically important (HR 2.08, 95% CI 1.03 to 4.20).
• The incidence of major bleeding events was twofold to threefold higher in women compared with men.
• In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3-5 HR 1.45, 95% CI 0.72 to 2.91).
• No interaction was seen between gender and effectiveness or safety of randomised treatment.