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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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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
Su Xi
Liu Feng
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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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VariableFemale group (n=117)Male group (n=220)P value
BMI23.8±2.727.3±3.1< 0. 01
 (%)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.
[1] O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. (2013). American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation,127: e362-e425
[2] Chen Y, Jiang L, Smith M, Pan H, Collins R, Peto R, et al. (2011). Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45 852 patients in the COMMIT/CCS-2 study. Heart Asia, 3:104-110
[3] Carro A, Kaski JC. Myocardial Infarction in the Elderly (2011). Aging Dis, 2: 116-137
[4] Pancholy SB, Shantha GP, Patel T, Cheskin LJ (2014). Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis. JAMA Intern Med, 174:1822-1830
[5] Wilkinson P, Laji K, Ranjadayalan K, Parsons L, Timmis AD (1994). Acute myocardial infarction in women: survival analysis in first six months. BMJ, 309: 566-569
[6] Du X, Spatz ES, Dreyer RP, Hu S, Wu C, Li X, et al. (2016). Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST-Segment Elevation Myocardial Infarction From 2001 to 2011: Insights from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Study. J Am Heart Assoc, 22: e002157
[7] Tillmanns H, Waas W, Voss R, Grempels E, Hölschermann H, Haberbosch W, et al. (2005). Gender differences in the outcome of cardiac interventions. Herz, 30: 375-389
[8] Laufer-Perl M, Shacham Y, Letourneau-Shesaf S, Priesler O, Keren G, Roth A, et al. (2015). Gender-related mortality and in-hospital complications following ST-segment elevation myocardial infarction: data from a primary percutaneous coronary intervention cohort. Clin Cardiol, 38:145-149
[9] Li J, Li X, Wang Q, Hu S, Wang Y, Masoudi FA, et al. (2015). ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet, 385: 441-451
[10] Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, et al. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J, 33: 2569-2619
[11] Schmidt M, Jacobsen JB, Lash TL, Bøtker HE, Sørensen HT (2012). 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ, 344: e356
[12] Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, et al. (2009). Sex differences in mortality following acute coronary syndromes. JAMA, 302: 874-882
[13] Claussen PA, Abdelnoor M, Kvakkestad KM, Eritsland J, Halvorsen S (2014). Prevalence of risk factors at presentation and early mortality in patients aged 80 years or older with ST-segment elevation myocardial infarction. Vasc Health Risk Manag, 10: 683-689
[14] Li ZY, Pu-Liu Chen ZH, An FH, Li LH, Li L, et al. (2014). Combined Effects of Admission Serum Creatinine Concentration with Age and Gender on the Prognostic Significance of Subjects with Acute ST-Elevation Myocardial Infarction in China. PLoS One, 9: e108986
[15] Gevaert SA, De Bacquer D, Evrard P, Renard M, Beauloye C, Coussement P, et al. (2013). Renal dysfunction in STEMI-patients undergoing primary angioplasty: higher prevalence but equal prognostic impact in female patients; an observational cohort study from the Belgian STEMI registry. BMC Nephrol, 14: 62
[16] Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. (2005). Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet, 366: 1640-1649
[17] Joyce E, Hoogslag GE, Kamperidis V, Debonnaire P, Katsanos S, Mertens B, et al. (2017). Relationship between myocardial function, body mass index, and outcome after ST-segment-elevation myocardial infarction. Circ Cardiovasc Imaging, 10:7. pii: e005670
[18] Angerås O, Albertsson P, Karason K, Råmunddal T, Matejka G, James S, et al. (2013). Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J, 34: 345-353
[19] Kirtane AJ, Kelly CR (2015). Clearing the air on the “smoker’s paradox”. J Am Coll Cardiol, 65:1116-1118
[20] Steele L, Lloyd A, Fotheringham J, Sultan A, Iqbal J, Grech EDet al. (2015). A retrospective cross-sectional study on the association between tobacco smoking and incidence of ST-segment elevation myocardial infarction and cardiovascular risk factors. Postgrad Med J, 91: 492-496
[21] Mons U, Muezzinler A, Gellert C, Schottker B, Abnet CC, Bobak M, et al. (2015). Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ, 350: h1551
[22] Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, et al. (2007). Symptom presentation of women with acute coronary syndromes myth vs reality. Arch Intern Med, 167: 2405-2413
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