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Aging and disease    2018, Vol. 9 Issue (5) : 852-860     DOI: 10.14336/AD.2017.1129
Orginal Article |
Gender Differences among Elderly Patients with Primary Percutaneous Coronary Intervention
Binquan You1, Bingbing Zhu1, Xi Su2, Feng Liu1, Bingyin Wang1,*
1Departments of Cardiology, Suzhou Kowloon Hospital, School of Medicine Shanghai Jiaotong University, Suzhou, 215000, China
2Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, 430000, China
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Abstract  

Several epidemiological and clinical studies have shown that females with ST-segment elevation myocardial infarction (STEMI) have a higher mortality than males following primary percutaneous coronary intervention (PPCI). Many analyses of sex-based differences following STEMI have revealed conflicting results. Currently, more and more elderly patients with STEMI have undergone emergency interventional therapy. From January 2014 to December 2016, a total of 337 elderly patients with STEMI were enrolled in this study from two chest pain centers, and all patients underwent PPCI. Patients were divided into two groups: elderly females (n=117, mean age 73.4±9.6 years) and elderly males (n=220, mean age 71.7±8.6 years). The prevalence of diabetes was higher in females than in males (29.1% vs. 19.6%,P<0. 01). Typical ischemic chest pain was lower in females than in males (45.3% vs 57.3%, P<0.01). The number of nonsmokers was also significantly higher in females than in males (5.1% vs. 52.3%,P<0. 01). Serum creatinine (sCr) levels (87.6±17.4 umol/L vs 99.5±20.2 umol/L,P<0.01) and body mass index (23.8±2.7 vs 27.3±3.1, P<0.01) were lower in females than in males. The incidences of major adverse cardiac events (MACE) in-hospital showed no significantly difference (P>0.05) between the two groups. However, the cumulative MACE showed a significant difference between the two groups in the 12-month follow-up (16.8% in male vs 12.8% in female, P = 0.04). Our results suggest that the PPCI is safe and effective in elderly female STEMI patients. The cumulative MACE in females are not higher than in males. PPCI are helpful in elderly STEMI patients.

Keywords ST-segment elevation myocardial infarction      elderly female      primary percutaneous coronary intervention      major adverse cardiac events     
Corresponding Authors: Bingyin Wang   
About author: These authors contributed equally to this work.
Issue Date: 13 October 2017
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You Binquan
Zhu Bingbing
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Cite this article:   
You Binquan,Zhu Bingbing,Su Xi, et al. Gender Differences among Elderly Patients with Primary Percutaneous Coronary Intervention[J]. Aging and disease, 2018, 9(5): 852-860.
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http://www.aginganddisease.org/EN/10.14336/AD.2017.1129     OR     http://www.aginganddisease.org/EN/Y2018/V9/I5/852
VariableFemale group (n=117)Male group (n=220)P value
Age73.4±9.671.7±8.60.15
BMI23.8±2.727.3±3.1< 0. 01
Smoking
 (%)Non-smoker105 (89.7)53 (24.1)< 0. 01
 Former-smoker6 (5.1)52 (23.6)< 0. 01
 Smoker6 (5.1)115 (52.3)< 0. 01
Peripheral artery disease (%)7 (6.0)10 (4.6)0.14
Dyslipidaemia (%)78 (66.7)142 (64.6)0.13
Hypertension (%)86 (73.5)155 (70.5)0.17
Diabetes mellitus (%)34 (29.1)43 (19.6)< 0. 01
Atrial fibrillation (%)11 (9.4)19 (8.6)0.15
History of stroke (%)11 (9.4)21 (9.6)0.22
History of cardiac arrest (%)2 (1.7)5 (2.3)0.12
Prior MI (%)5 (4.3)13 (5.9)0.11
Prior PCI (%)7 (6.0)19 (8.64)0.08
Prior CABG (%)1 (0.86)3 (1.36)0.21
prior to admission (%)29 (24.8)65 (29.6)0.06
Presenting symptoms
Typical anginal chest pain (%)53 (45.3)126 (57.3)< 0. 01
Atypical chest pain (%)38 (32.5)67 (30.5)0.22
No chest pain (%)26 (22.2)27 (12.3)< 0. 01
Killip class (preoperative, %)
161 (52.1)128 (58.2)0.17
229 (24.8)57 (25.9)0.26
317 (14.5)30 (13.6)0.28
410 (8.6)15 (6.8)0.19
MI localization in ECG (%)
anterior wall47 (40.2)101 (45.9)0.11
inferior wall40 (34.2)86 (39.1)0.10
Others30 (25.6)33 (15.0)0.03
Troponin I on admission (ng/ml)5.7±3.21.90±2.1< 0. 01
sCr on admission (umol/L)87.6 ± 17. 499.5 ± 20.2< 0. 01
Blood glucose on admission (mmol/L)7.2 ± 3.27.0 ± 2.90.25
Table 1  Baseline characteristics of the two groups.
VariableWomen (n= 117)Men (n= 220)P value
Infarct-related coronary artery (%)
Left main coronary artery1 (0.85)3 (1.36)0.18
Left anterior descending artery47 (40.2)101 (45.9)0.09
Circumflex artery25 (21.4)41 (18.6)0.08
Right coronary artery44 (37.6)75 (34.1)0.14
Emergency Call (%)14 (11.97)43 (19.09)< 0. 01
S-to-B (min)460.8±81.9400.4±75. 5< 0. 01
FMC-to-B (min)1091160.26
Door-to-balloon time (min)74.38±19.7672.65±20.760.20
Thrombuster (%)7(5.98)18 (8.2)0.07
IABP (%)9(7.7)17 (7.7)0.31
Temporary pacing (%)14(12.0)21 (9.6)0.19
Medical therapy (%)
Aspirin115 (98.3)218 (99.1)0.29
Clopidogrel/Tegreino113 (96.6)215 (97.7)0.19
β-blocks85 (72.6)162 (73.6)0.21
ACEI/ARB98 (83.8)186 (84.5)0.26
Statins107 (91.5)202 (91.8)0.29
Severity of CAD (%)
one-vessel36 (30.8)67 (30.5)0.37
two-vessel58 (49.6)121 (55.0)0.06
three-vessel23 (19.7)32 (14.6)0.04
Preoperative TIMI 0-1 (%)102 (87.1)201 (91.4)0.09
Postoperative TIMI (%)
396 (82.1)184 (83.6)0.19
215 (12.8)22 (10.0)0.16
0-16 (5.1)14 (6.4)0.17
Operative time(min)60.2 ± 13.656. 3±11.80.10
Successful PCI (%)105 (89.7)201 (91.4)0.22
Stent number1.38±0.761.36±0.900.25
Stent diameter (mm)2.89±0.793.35±0.940.17
Stent length (mm)31.51±3.0833.45±3.340.13
Average length of hospital stays (d)10.73±3.229.65±2.860.10
Table 2  Comparison of characteristics of coronary artery lesions in the two groups.
Figure 1.  The Kaplan-Meier survival curves of Cumulative MACE during one-year follow-up in two groups.
VariableFemale (n=117)Male (n=220)P value
In hospital (%)
CHF need treatment23 (19.7)41 (18.6)0.15
Bleeding complication19 (16.2)30 (13.6)0.02
Severe arrhythmia22 (18.8)47 (21.4)0.03
Myocardial infarction2 (1.71)4 (1.8)0.37
Stroke1 (0.86)1 (0.46)0.48
Cardiogenic shock7 (5.13)10 (4.55)0.27
In-hospital death3 (2.56)6 (2.73)0.37
MACE6 (5.13)11 (5.00)0.60
One month (%)
Myocardial infarction3 (2.56)6 (2.73)0.07
Cardiac death5 (4.27)10 (4.55)0.15
Stroke0 (0.00)1 (0.46)0.18
MACE8 (6.84)17 (7.73)0.11
In 12 months
Myocardial infarction4 (3.42)10 (4.55)0.09
Cardiac death10 (8.55)23 (10.45)0.11
Stroke2 (1.71)4 (1.82)0.58
MACE15 (12.82)37 (16.82)0.04
Table 3  Cumulative MACE during one - year follow-up in two groups.
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