P4661Sex difference in mortality among patients with acute myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

J.-S. Jang, Y.-A. Park, H.-Y. Jin, J.-S. Seo, T.-H. Yang, D.-K. Kim, D.-S. Kim
2017 European Heart Journal  
Conclusions: In routine clinical practice a significant proportion of patients with SCAD present concomitant coronary atherosclerosis. A-SCAD is associated with patient demographics (male sex and cardiovascular risk factors), but its clinical presentation, management and prognosis are not different from I-SCAD. STEMI as clinical presentation constitutes the major determinant of prognosis for patients with SCAD. Background: The diagnosis of MI is often challenging when LBBB is present. Purpose:
more » ... o investigate new ECG algorithms that could improve our ability to diagnose acute myocardial infarction (MI) in the presence of left bundle branch block (LBBB). Methods: Multicenter retrospective observational cohort study that included all patients with suspected MI and LBBB on presenting ECG, referred for primary percutaneous coronary intervention (pPCI) at four tertiary hospitals. Three newly developed algorithms were evaluated and compared with Sgarbossa and Smith rules. ST segment elevation MI (STEMI) is essentially an electrocardiographic diagnosis whose criteria do not apply to patients with LBBB. Thus, we defined a clinical and angiographic "STEMI equivalent" in the presence of an acutely occluded coronary artery or an acute coronary lesion associated with a significant rise in cardiac biomarkers (cardiac troponin I and T >10 times over the upper normal limit, creatine kinase MB isozyme >5 times over the upper normal limit). Results: 145 patients were included. 54 (37%) had a STEMI equivalent. The ECG algorhitm that performaed best (new algorithm III) was considered positive in the presence of any of the following criteria: concordant ST elevation ≥1mm in any lead (one of Sgarbossa criteria), concordant ST depression ≥1mm in any lead or discordant ST deviation ≥1mm in any lead with the main deflection of the QRS ≤6mm. This algorithm showed the highest efficiency (88%), highest sensitivity (94%) and highest negative predictive value (96%); its sensitivity was significantly higher than both Sgarbossa and Smith rules (p<0.001). New algorithm III had a specificity of 85%, similar to Smith rules. Smith I rule: Sgarbossa score ≥3 AND/OR ST elevation/S ≤-0.25. New algorithm III: Concordant ST elevation ≥1mm AND/OR concordant ST depression ≥1mm in any lead AND/OR discordant ST deviation ≥1mm in a leadwith main QRS deflection ≤6mm. Background: It remains unclear if a gender difference in outcomes exists and if this difference in clinical outcomes between genders is a confounded observation due to baseline differences in comorbidities and procedural characteristics. Purpose: We aimed to assess whether gender specific difference in mortality exists among patients presenting with ST-Elevation Myocardial Infarction (STEMI) and received primary percutaneous coronary intervention (PCI). Methods: We identified relevant studies through electronic searches of MED-LINE, EMBASE, and the Cochrane Central Register of Controlled Trials published up to October 2016. The main analysis of this study was comparison of all-cause Downloaded from https://academic.oup.com/eurheartj/article-abstract/38/suppl_1/ehx504.P4661/4090707 by guest on Background: The clinical impact of routine intracoronary thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with STsegment elevation myocardial infarction (STEMI) is unclear. We investigated to Downloaded from https://academic.oup.com/eurheartj/article-abstract/38/suppl_1/ehx504.P4661/4090707 by guest on
doi:10.1093/eurheartj/ehx504.p4661 fatcat:gxeftt67vva4xgewsaggyrse2e