The impact of gender on long-term mortality in patients with multivessel disease after primary percutaneous coronary intervention.

BACKGROUND: Gender and complete revascularisation are known to affect mortality. The objective of this study was to analyse a gender difference in mortality with respect to complete revascularisation for multivessel disease after primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) patients. METHOD: In a prospective consecutive cohort of 1472 patients presenting with STEMI for PPCI, between January 2006 and January 2010, 832 patients with multivessel disease were analysed. The primary outcome was long-term mortality. RESULTS: Median follow-up was 3.3 ± 1.2 years. Complete revascularisation was performed less in females than in males (30 vs. 38 %; p = 0.04). At PPCI, women (27 %, n = 221) were ± 10 years older (p = 0.001), had more hypertension, renal failure and symptoms of heart failure (all p < 0.01). Cumulative long-term mortality with incomplete revascularisation was higher in females (F: 30 vs. M: 15 %, p = 0.01). After adjustment for baseline characteristics, complete revascularisation (0.84; 95 % CI 0.54-1.32) and gender (1.11; 95 % CI 0.73-1.69) lost significance. Also the gender-by-complete revascularisation interaction was not significant at long term. In women, age under 60 years independently predicted higher mortality (HR 10.09; 95 % CI 3.08-33.08; p < 0.001). CONCLUSION: In STEMI patients with multivessel disease at PPCI, women under the age of 60 years had higher mortality, but in women older than 60 years comorbidity impacted the outcome of revascularisation strategy in the long term.

Prediction of success and major complications during elective coronary angioplasty.

BACKGROUND: Complications from coronary angioplasty remain a concern despite improvements in technology and operator's skills. Identification of high-risk patients is important with regard to surgical standby and other precautions that have to be taken for such patients. METHODS: Prior to elective coronary angioplasty, the probability of success and the risk of complications were estimated on the basis of angiographic and clinical characteristics. A total of 2365 consecutive elective procedures were evaluated. Estimates for success and complications were classified into three categories: high, intermediate or low probability. RESULTS: Angioplasty success was achieved in 1025 of 1056 (97%) procedures with high success probability; in 833 of 914 (91%) with intermediate success probability and 304 of 395 (77%) with low success probability. Complications occurred in five of 271 (2%) procedures with an anticipated low risk of complications, in 72 of 1973 (4%) procedures with a intermediate risk and in 13 of 121 (11%) procedures with a high risk of complications. Out of a total of 28, 22 (80%) surgical bypass procedures were performed in the intermediate anticipated risk category. CONCLUSIONS: For groups of patients, reliable prediction of success and complications is possible. However, most emergency bypass surgery after failed angioplasty is performed in patients with a predicted intermediate risk of complications. Interventional cardiologists are not able to identify in advance the majority of patients who will need surgery for failed angioplasty.