CLINICAL RESEARCH Acute Coronary Syndromes Gender and Myocardial Salvage After Reperfusion Treatment in Acute Myocardial Infarction

OBJECTIVES The aim of this study was to investigate whether there are gender-associated differences in theamount of myocardial salvage after primary percutaneous coronary intervention (PCI) inpatients with acute myocardial infarction (AMI).BACKGROUND Despite having a more adverse cardiovascular risk profile, women with AMI have similar oreven better outcomes after primary PCI compared with men. The reasons for these findingsare unclear.METHODS In this study we included 202 women and 561 men with AMI who underwent primary PCIin the setting of three randomized trials. The primary end point of the study was myocardialsalvage index (proportion of initial perfusion defect salvaged by reperfusion therapy), obtainedby paired scintigraphic studies performed 7 to 10 days apart.RESULTS The amount of myocardium at risk or initial perfusion defect (median [25th, 75thpercentiles]) did not differ significantly between women and men (22.0% [12.0, 40.0] vs.24.0% [14.0, 39.0] of the left ventricle [LV], p 0.26). Final infarct size, measured in thefollow-up scintigraphy, was significantly smaller in women than in men (6.0% [0.71, 18.7] vs.10.0% [3.9, 21.8] of the LV, p 0.001). Myocardial salvage index was 0.64 (0.35, 0.95) inwomen versus 0.50 (0.26, 0.77) in men (p 0.001). After adjustment for baselinecharacteristics, female gender was an independent predictor of greater myocardial salvage afterPCI (p 0.002).CONCLUSIONS The efficacy of primary PCI in patients with AMI appears to be gender-dependent.Myocardial salvage achieved by primary PCI is greater in women than in men. (J Am CollCardiol 2005;45:828–31) © 2005 by the American College of Cardiology Foundation