TY - JOUR
T1 - Impact of gender differences on myocardial salvage and post-ischaemic left ventricular remodelling after primary coronary angioplasty
T2 - new insights from cardiovascular magnetic resonance
AU - Canali, Emanuele
AU - Masci, Pier
AU - Bogaert, Jan
AU - Bucciarelli Ducci, Chiara
AU - Francone, Marco
AU - McAlindon, Elisa
AU - Carbone, Iacopo
AU - Lombardi, Massimo
AU - Desmet, Walter
AU - Janssens, Stefan
AU - Agati, Luciano
PY - 2012/11
Y1 - 2012/11
N2 - AIMS: There is conflicting evidence on the impact of gender on reperfusion after primary coronary angioplasty (PPCI), and on left ventricular (LV) remodelling (LVR). In a cohort of patients with reperfused ST elevation myocardial infarction (STEMI), gender-related differences on myocardial reperfusion, and sex-related differences on LVR were assessed by using a comprehensive cardiac magnetic resonance (CMR) approach.METHODS AND RESULTS: In four tertiary referral centres, 283 (238 males and 45 females) consecutive STEMI patients, treated with PPCI within 12 h from symptoms onset underwent CMR 3 ± 2 days after STEMI and at 4-month follow-up. By CMR, the area at risk, infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) were assessed. Women were older than men (P = 0.014), more hypertensive (P < 0.001) and more frequently presented with pre-infarct angina (P = 0.018). An MSI extent was significantly higher (P = 0.013), IS was significantly smaller at both time points (acute P < 0.001, follow-up P < 0.001), and the MVO extent was significantly smaller (P < 0.001) in women. At multivariate analysis, Killip class and female sex were independently associated with a higher MSI (P = 0.02, P = 0.05, respectively). A similar incidence of LVR in both sexes was observed at follow-up (P = 0.808).CONCLUSIONS: The better reperfusion pattern observed in women by CMR in our population of reperfused STEMI suggests sex-based differences exist. No gender differences were observed with respect to incidence of LV remodelling at the follow-up mainly occurring in the subset of patients with a larger IS.
AB - AIMS: There is conflicting evidence on the impact of gender on reperfusion after primary coronary angioplasty (PPCI), and on left ventricular (LV) remodelling (LVR). In a cohort of patients with reperfused ST elevation myocardial infarction (STEMI), gender-related differences on myocardial reperfusion, and sex-related differences on LVR were assessed by using a comprehensive cardiac magnetic resonance (CMR) approach.METHODS AND RESULTS: In four tertiary referral centres, 283 (238 males and 45 females) consecutive STEMI patients, treated with PPCI within 12 h from symptoms onset underwent CMR 3 ± 2 days after STEMI and at 4-month follow-up. By CMR, the area at risk, infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) were assessed. Women were older than men (P = 0.014), more hypertensive (P < 0.001) and more frequently presented with pre-infarct angina (P = 0.018). An MSI extent was significantly higher (P = 0.013), IS was significantly smaller at both time points (acute P < 0.001, follow-up P < 0.001), and the MVO extent was significantly smaller (P < 0.001) in women. At multivariate analysis, Killip class and female sex were independently associated with a higher MSI (P = 0.02, P = 0.05, respectively). A similar incidence of LVR in both sexes was observed at follow-up (P = 0.808).CONCLUSIONS: The better reperfusion pattern observed in women by CMR in our population of reperfused STEMI suggests sex-based differences exist. No gender differences were observed with respect to incidence of LV remodelling at the follow-up mainly occurring in the subset of patients with a larger IS.
KW - Age Factors
KW - Aging
KW - Angioplasty, Balloon, Coronary
KW - Female
KW - Health Status Indicators
KW - Heart Ventricles
KW - Humans
KW - Magnetic Resonance Imaging, Cine
KW - Male
KW - Middle Aged
KW - Myocardial Infarction
KW - Myocardial Ischemia
KW - Myocardial Reperfusion
KW - Myocardium
KW - Prospective Studies
KW - Sex Factors
KW - Statistics as Topic
KW - Time Factors
KW - Ventricular Remodeling
U2 - 10.1093/ehjci/jes087
DO - 10.1093/ehjci/jes087
M3 - Article (Academic Journal)
C2 - 22531464
VL - 13
SP - 948
EP - 953
JO - European Heart Journal - Cardiovascular Imaging
JF - European Heart Journal - Cardiovascular Imaging
SN - 2047-2404
IS - 11
ER -