Angioplastia primária na mulher: realidade nacional

• Main Authors: Rita Calé, Lídia de Sousa, Hélder Pereira, Marco Costa, Manuel de Sousa Almeida
• Format: Article
• Language: English
• Published: Elsevier 2014-06-01
• Series: Revista Portuguesa de Cardiologia
• Online Access: http://www.sciencedirect.com/science/article/pii/S0870255114000158

Resumo: Objetivos: A mortalidade na mulher após angioplastia primária (ICP‐P) é superior à do homem. Contudo, permanece contraditório o papel do sexo poder ser fator de risco independente para mortalidade no contexto de enfarte agudo do miocárdio com supradesnivelamento de ST (EAMST). Com base no Registo Nacional de Cardiologia de Intervenção (RNCI), pretendemos avaliar como é que o género feminino influencia o prognóstico a curto prazo nos doentes com EAMST submetidos a ICP‐P a nível nacional. Métodos: De 60 158 doentes incluídos prospetivamente no RNCI de 2002‐2012, incluímos na análise 7544 doentes com EAMST tratados por ICP‐P, dos quais 25% foram mulheres. Utilizámos modelos de regressão logística e ajustamento por propensity score para avaliar o impacto do sexo na mortalidade hospitalar. Resultados: As mulheres foram mais idosas (68 ± 14 versus 61 ± 13, p < 0,001), mais diabéticas (30 versus 21%, p < 0,001) e hipertensas (69 versus 55%, p < 0,001). Os homens foram revascularizados mais cedo (71 versus 63% nas primeiras 6 horas, p < 0,001). Choque cardiogénico foi mais frequente nas mulheres (7,1 versus 5,7%, p = 0,032). Estas apresentaram um pior prognóstico a curto prazo, com 1,7 x maior risco de morte intra‐hospitalar (4,3 versus 2,5%; IC 95% 1,30‐2,27; p < 0,001). Utilizando um modelo de regressão ajustado através de um propensity score, o sexo deixa de ser preditor de mortalidade hospitalar (OR 1,00; IC 95% 0,68‐1,48; p = 1,00). Conclusões: No RNCI as mulheres com EAMST tratadas com ICP‐P apresentaram maior risco cardiovascular, um acesso menos atempado a ICP‐P e um pior prognóstico. Contudo, após ajustamento do risco, o género feminino deixa de ser preditor independente de mortalidade hospitalar. Abstract: Aims: Although mortality after primary percutaneous coronary intervention (PPCI) is higher in women than in men, there is disagreement as to whether gender is an independent risk factor for mortality in ST‐ elevation myocardial infarction (STEMI). Our aim was to assess how gender influenced short‐term prognosis in patients undergoing PPCI in the Portuguese Registry of Interventional Cardiology. Methods: Of 60 158 patients prospectively included in a large registry of contemporary PCI, from 2002 to 2012, we included 7544 patients with STEMI treated by PPCI, of whom 1856 (25%) were female. The effect of gender on in‐hospital mortality was assessed by multivariate logistic regression analysis with propensity score matching. Results: Women were older (68±14 vs. 61±13 years, p<0.001), with a higher prevalence of diabetes (30% vs. 21%, p<0.001) and hypertension (69% vs. 55%, p<0.001). Men were more frequently revascularized within six hours of symptom onset (71% vs. 63%, p<0.001). Cardiogenic shock was more frequent in women (7.1% vs. 5.7%, p=0.032). Female gender was associated with a worse short‐term prognosis, with 1.7 times higher risk of in‐hospital death (4.3% in women and 2.5% in men, 95% confidence interval (CI) 1.30‐2.27, p<0.001). After computed propensity score matching based on baseline clinical characteristics, in‐hospital mortality was similar between women and men (odds ratio 1.00, 95% CI 0.68‐1.48, p=1.00). Conclusions: In the Registry, women with STEMI treated by PPCI had a greater risk‐factor burden, less timely access to treatment and a worse prognosis. However, after risk adjustment, female gender ceases to be an independent predictor of in‐hospital mortality. Palavras‐chave: Angioplastia primária, Enfarte agudo do miocárdio com supradesnivelamento de ST, Sexo feminino, Keywords: Primary angioplasty, ST‐elevation myocardial infarction, Female