Abstract P202: Do Cardiac Hemodynamic Differences in Patients with Acute ST-Elevation Myocardial Infarction Contribute to Gender Differences in Outcomes?

Aim: Previous studies demonstrate higher 30-day all-cause mortality and re-infarction amongst women with ST-elevation myocardial infarction (STEMI). This study examines if gender differences exist in cardiac hemodynamic parameters assessed during an acute STEMI. Methods: The clinical, angiographic and hemodynamic features of 470 consecutive patients undergoing emergency primary percutaneous coronary intervention for an acute STEMI were evaluated with respect to gender. Patients routinely underwent right heart catheterization using a Swan-Ganz catheter, during the emergency reperfusion therapy procedure. Infarct size was estimated by evaluating the peak creatinine kinase (CK) levels. Results: The 135 STEMI female patients were significantly older than males (69±13 vs. 60±12 years, P <0.001) so subsequent analyses were age-adjusted. The findings are summarized below (*p < 0.05, **p<0.001 compared with men). Multivariate logistic regression analysis revealed that pulmonary capillary wedge pressure (PCWP) was the strongest independent predictor of 30-day death and re-infarction (Odds Ratio for PCWP = 1.06 (95% CI = 1.01 - 1.12, p = 0.019). Conclusion: Women with an acute STEMI have a higher 30-day cardiac event rate despite similar extent of coronary artery disease, infarct size and site. However they do have higher left ventricular filling pressures, which is consistent with their poorer outcomes. The mechanism/s of this hemodynamic difference requires further investigation. Clinical and Hemodynamic Features of STEMI patients (Expressed as Mean ± SD or frequency data) Men (n = 335) Women (n =135) Acute Anterior STEMI on ECG 128 (41%) 53 (40%) Peak Creatine Kinase 2309±5894 IU 1455±1797 IU Multi-vessel disease on angiography 168 (51%) 61 (49%) Initial Heart Rate 80±22 bpm 79±25 bpm Initial systolic blood pressure 137±29 mmHg 145±99 mmHg Pulmonary capillary wedge pressure 16±7 mmHg 20±7 mmHg* Arterial oxygen saturation 97±4.5% 97±2.9% Mixed venous oxygen saturation 70±9% 67±10% 30 Day All cause Mortality/Re-Infarction 14 (4%) 15 (11%)*