Objectives A higher mortality risk for women with acute ST elevation myocardial infarction (STEMI) has been a common finding in the past. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI) with focus on early reperfusion in China.

Methods We assessed 578 patients with STEMI undergoing acute coronary angiography with the intention of primary PCI between January 2007 and December 2012. Data were examined for gender-specific differences regarding patients characteristics, angiographic findings, procedural details, and in-hospital mortality after PCI.

Results A total of 123 women and 455 men were included in the study. Compared with men, women were 7 years older than men, and more frequently had a history of hypertension and diabetes mellitus. Men were more likely to be smokers. Female sex was associated with a higher unadjusted in-hospital mortality (8.9% vs. 4.4%; P = 0.047). After multivariable adjustment this sex difference disappeared.

Conclusions Female sex is associated with an apparent hazard of increased mortality among patients undergoing primary PCI for STEMI, but this difference is likely explained by older age and worse baseline comorbidities among women.