Figure 1: CONSORT Flow Diagram
|
|
Male |
Female |
P value |
Clinical Characteristics |
||||
Age |
|
59 |
65 |
<0.001 |
Systolic BP |
|
130 |
129 |
0.51 |
Diastolic BP |
|
78 |
73 |
<0.001 |
Heart rate |
|
78 |
80 |
0.045 |
Hypertension |
|
1466 (51.5) |
440 (60.4) |
<0.001 |
Hypercholesterolaemia |
|
1532 (53.9) |
379 (52.2) |
0.431 |
Diabetes |
No |
2022 (71.3) |
481 (66.3) |
0.021 |
|
Type 1 |
66 (2.3) |
24 (3.3) |
|
|
Type 2 |
746 (26.3) |
220 (30.3) |
|
Smoker |
No |
953 (33.7) |
349 (48.2) |
<0.001 |
|
Previous |
719 (25.4) |
144 (19.9) |
|
|
Current |
1156 (40.9) |
231 (31.9) |
|
Family history of early cardiac disease |
1142 (40.9) |
283 (39.9) |
0.855 |
|
Previous ischaemic heart disease |
672 (23.7) |
175 (24.2) |
0.794 |
|
Previous coronary artery bypass graft |
105 (3.7) |
18 (2.5) |
0.136 |
|
Previous PCI |
|
371 (13.1) |
63 (8.7) |
0.001 |
Previous CVA/TIA |
|
120 (4.2) |
51 (7.1) |
0.002 |
Renal impairment |
|
354 (12.2) |
88 (11.7) |
0.756 |
Lung disease |
|
251 (10.2) |
104 (16.9) |
<0.001 |
Medications at Presentation |
||||
Aspirin or dipyridamole |
553 (19.5) |
160 (22.2) |
0.119 |
|
Antiplatelets |
|
180 (6.4) |
37 (5.1) |
0.259 |
ACE inhibitors |
|
364 (12.9) |
81 (11.4) |
0.303 |
Angiotensin receptor antagonists |
326 (11.5) |
121 (16.8) |
<0.001 |
|
Beta blockers |
|
363 (12.8) |
111 (15.4) |
0.080 |
Calcium channel blockers |
254 (9.0) |
85 (11.8) |
0.026 |
|
Statin/lipid lowering agents |
689 (24.3) |
190 (26.3) |
0.289 |
|
Diuretics |
|
76 (2.7) |
40 (5.5) |
<0.001 |
Nitrates |
|
120 (4.3) |
47 (6.5) |
0.014 |
Presentation Characteristics |
||||
Presenting Hospital |
Tertiary Centre |
923 (31.7) |
263 (34.8) |
0.112 |
Other |
1987 (68.3) |
492 (65.2) |
|
|
Transport |
ETAMI/PAPA |
853 (30.0) |
220 (30.0) |
0.015 |
Ambulance |
1161 (40.8) |
336 (45.8) |
|
|
Private Vehicle |
829 (29.2) |
178 (24.2) |
|
|
In-hours presentation |
|
1838 (63.4) |
485 (64.7) |
0.549 |
Rhythm |
Sinus |
2484 (85.9) |
613 (81.8) |
0.001 |
Atrial fibrillation |
108 (3.7) |
26 (3.5) |
|
|
VT/VF |
102 (3.5) |
27 (3.6) |
|
|
Bradycardia |
150 (5.2) |
55 (7.3) |
|
|
LBBB |
14 (0.5) |
6 (0.8) |
|
|
1st deg AVB |
14 (0.5) |
4 (0.5) |
|
|
2nd deg AVB |
4 (0.1) |
2 (0.3) |
|
|
3rd deg AVB |
17 (0.6) |
16 (2.1) |
|
|
Infarct region on ECG |
Anterior |
1051 (36.3) |
288 (38.1) |
0.147 |
Inferior |
1272 (43.9) |
324 (42.9) |
|
|
Lateral |
87 (3.0) |
26 (3.4) |
|
|
Anterior + lateral |
258 (8.9) |
50 (6.6) |
|
|
LBBB |
10 (0.3) |
7 (0.9) |
|
|
Inferior + lateral |
173 (6.0) |
49 (6.5) |
|
|
Inferior + anterior |
47 (1.6) |
11 (1.5) |
|
|
Angiography |
Normal/Minor |
8 (0.3) |
11 (1.5) |
<0.001 |
1VD |
1347 (46.5) |
371 (49.5) |
|
|
2VD |
824 (28.5) |
202 (27.0) |
|
|
3VD/LMD |
717 (24.8) |
165 (22.0) |
|
|
Cardiogenic shock |
|
317 (21.9) |
113 (28.6) |
0.006 |
Table 1: Baseline Characteristics of STEMI Patients by Gender
Abbreviations: ACE inhibitor: Angiotensin Converting Enzyme Inhibitor, AVB: atrioventricular block, CVA/TIA: Cerebrovascular Accident/Transient Ischaemic Attack; ETAMI: Emergency Triage of Acute Myocardial Infarction, PAPA: Pre-hospital Assessment for Primary Angioplasty, PCI: Percutaneous Coronary Intervention; STEMI: ST-Elevation Myocardial Infarction, 1VD: single vessel disease, 2VD: double vessel disease, 3VD/LMD: triple vessel or left main disease
|
Model 1: MACE |
Model 2: Mortality |
||
|
HR (95% CI) |
P value |
HR (95% CI) |
P value |
Gender (Female) |
1.15 (0.85 - 1.58) |
0.37 |
1.04 (0.71 - 1.52) |
0.85 |
Age (per 10yrs) |
1.26 (10.2 - 10.4) |
<0.001 |
1.50 (10.4 - 10.7) |
<0.001 |
Hypertension (Yes) |
0.89 (0.68 - 1.17) |
0.41 |
0.76 (0.54 - 1.08) |
0.13 |
Diabetes (Yes) |
1.41 (1.07 - 1.85) |
0.01 |
1.71 (1.22 - 2.41) |
0.01 |
Smoking Status (Exsmoker) |
0.61 (0.44 - 0.87) |
0.01 |
0.56 (0.36 - 0.87) |
0.01 |
Smoking Status (Current) |
0.73 (0.53 - 0.99) |
0.05 |
0.67 (0.44 - 1.01) |
0.56 |
Renal Impairment (Yes) |
1.66 (1.22 - 2.26) |
0.001 |
2.03 (1.41 - 2.92) |
<0.001 |
Angiography (Multivessel) |
53.1 (0.01 - 341) |
0.87 |
17.8 (0.01 - 104) |
0.89 |
Cardiogenic shock (Yes) |
2.97 (2.27 - 3.87) |
<0.001 |
4.6 (3.27 - 6.59) |
<0.001 |
Table 2: Cox Multivariate Hazard Models of MACE and Mortality at 24 Months Post STEMI
Figure 1: CONSORT Flow Diagram
Figure 2: Rates of Major Adverse Coronary Events & Mortality Post STEMI by Gender
|
30 day |
6mth |
12mth |
24mth |
||||
|
Male |
Female |
Male |
Female |
Male |
Female |
Male |
Female |
MACE (n,%) |
150 (5.4) |
85 (11.8) |
186 (9.6) |
96 (19.5) |
208 (11.9) |
106 (23.3) |
249 (17.0) |
110 (28.0) |
Death |
150 (5.4) |
85 (11.8) |
169 (8.7) |
92 (18.7) |
191 (10.9) |
104 (22.9) |
220 (15.0) |
106 (27.0) |
Stroke |
14 (0.5) |
7 (1.0) |
3 (0.2) |
0 (0.0) |
3 (0.2) |
1 (0.2) |
7 (0.5) |
0 (0.0) |
Repeat infarct |
19 (0.7) |
6 (0.8) |
14 (0.7) |
4 (0.8) |
14 (0.8) |
1 (0.2) |
22 (1.5) |
4 (1.0) |
CABG |
99 (3.6) |
20 (2.8) |
29 (1.5) |
8 (1.6) |
11 (0.6) |
5 (1.1) |
9 (0.6) |
0 (0.0) |
Mortality (n,%) |
150 (5.4) |
85 (11.8) |
169 (8.7) |
92 (18.7) |
191 (10.9) |
104 (22.9) |
220 (15.0) |
106 (27.0) |
Figure 3: Kaplan Meier Survival Estimates of Secondary Outcomes (MACE, Mortality)
(A) Kaplan-Meier curve for Major Adverse Coronary Events Post STEMI by Gender
(B) Kaplan-Meier curve for All-Cause Mortality Post STEMI by Gender
Tables at a glance
Figures at a glance