Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction

Maznyczka, A. M. et al. (2019) Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction. Open Heart, 6(1), e000979. (doi: 10.1136/openhrt-2018-000979) (PMID:31168381) (PMCID:PMC6519583)

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Abstract

Objectives: We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI). Methods: Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up. Results: In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation. Conclusion: There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McEntegart, Dr Margaret and Carrick, Dr David and Mangion, Dr Kenneth and Hood, Dr Stuart and Maznyczka, Dr Annette Marie and Eteiba, Dr Hany and Welsh, Dr Paul and Petrie, Professor Mark and Oldroyd, Dr Keith and Carberry, Miss Jaclyn and Ford, Professor Ian and Berry, Professor Colin and Sattar, Professor Naveed
Authors: Maznyczka, A. M., Carrick, D., Carberry, J., Mangion, K., McEntegart, M., Petrie, M. C., Eteiba, H., Lindsay, M., Hood, S., Watkins, S., Davie, A., Mahrous, A., Ford, I., Welsh, P., Sattar, N., Oldroyd, K. G., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Open Heart
Publisher:BMJ Publishing Group
ISSN:2053-3624
ISSN (Online):2053-3624
Published Online:29 April 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Open Heart 6(1):e000979
Publisher Policy:Reproduced under a Creative Commons License

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612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES
744211T-TIME Coronary Physiology StudyColin BerryBritish Heart Foundation (BHF)FS/16/74/32573RI CARDIOVASCULAR & MEDICAL SCIENCES