NonSTSegment Elevation Myocardial Infarction

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Few studies have specifically addressed the influence of gender differences on the outcome of patients who present with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization procedures. Women who present with non-ST-segment elevation myocardial infarction that undergo angioplasty are consistently older, and have an increased incidence of hypertension with a preserved left ventricular ejection fraction when compared men. In one study, 941 women who underwent coronary angioplasty had a similar success, in-hospital mortality, and emergency coronary artery bypass surgery rate as men and overall survival during a mean follow-up period of 4 yr was comparable. Although women were more likely to experience severe angina than men, women were less likely to undergo coronary artery bypass grafting during this time (141).

Women with unstable angina or non-Q wave myocardial infarction enrolled in the TIMI-IIIB trial were older with a higher prevalence of diabetes and hypertension, and were more likely to be given a trial of medical therapy compared to men. Although women were less likely to have significant epicardial coronary artery disease at cardiac catheterization, the 42-d rate of death and myocardial infarction was similar (142). These findings were confirmed in the Global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) Registry. At cardiac catheterization, women had less severe epicardial coronary artery stenoses and were more likely than men to have insignificant coronary artery disease (25 vs 14%, p = 0.0001) (143).

A recent series evaluated outcome in 101 women who presented with non-Q wave infarction and underwent percutaneous revascularization during that hospitalization. Procedural success rates were similar for women and men, although women were less likely to undergo multivessel intervention. In-hospital adverse cardiac events were similar between men and women, although there was a trend towards a higher in-hospital death rate in women (4 vs 1%, p = 0.058), and at 1-yr follow-up, women had a significantly worse survival rate than men (89 vs 95%, p < 0.04) (144).

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