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Acute coronary syndromes

The impact of gender on outcomes of patients with ST elevation myocardial infarction transported for percutaneous coronary intervention: analysis of the PRAGUE-1 and 2 studies

Z Motovska¹, P Widimsky¹, M Aschermann², on behalf of The PRAGUE Study Group Investigators

¹ 3rd Faculty of Medicine, Charles University and Cardiocentre Kralovske Vinohrady, Prague, Czech Republic
² 1st Medical Faculty of Charles University, Prague, Czech Republic

Zuzana Motovska, MD, PhD, 3rd Medical Faculty of Charles University, Cardiocentre University Hospital Vinohrady, Srobarova 50, 100 34 Prague 10, Czech Republic; zuzana.motovska{at}iex.cz

Background: Data comparing survival outcomes for women versus men transported for pPCI were absent.

Objectives: To assess the impact of gender on 30-day mortality of patients with STEMI transported for pPCI.

Methods: The data from the PRAGUE-1 and PRAGUE-2 trials were analysed. Studies compared thrombolysis in the community hospital and pPCI after transportation to cardiocentre. A group of 520 patients treated with thrombolysis, and 530 transported for pPCI, were analysed.

Results: Women were older, with a higher risk profile. They had longer ischaemia time. Mortality of patients treated with TL was significantly higher in women than in men (15% vs 9%, p = 0.043). There was no significant gender difference in mortality in the PCI group (8.2% of women vs 6.2% of men, p = 0.409). Mortality of women treated with on-site TL was nearly twice as high as mortality of women transported for pPCI (p = 0.043). After adjustment in a multivariate model the odds ratio for mortality in women was 0.74 (95% CI 0.26 to 2.05; p = 0.556).

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.

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