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Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials

BACKGROUND: Sex- and gender-associated differences determine the disease response to treatment. AIM: The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. METHODS AND RESULTS: We performed an analysis of t...

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Autores principales: Motovska, Zuzana, Hlinomaz, Ota, Aschermann, Michael, Jarkovsky, Jiri, Želízko, Michael, Kala, Petr, Groch, Ladislav, Svoboda, Michal, Hromadka, Milan, Widimsky, Petr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9845716/
https://www.ncbi.nlm.nih.gov/pubmed/36684569
http://dx.doi.org/10.3389/fcvm.2022.953567
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author Motovska, Zuzana
Hlinomaz, Ota
Aschermann, Michael
Jarkovsky, Jiri
Želízko, Michael
Kala, Petr
Groch, Ladislav
Svoboda, Michal
Hromadka, Milan
Widimsky, Petr
author_facet Motovska, Zuzana
Hlinomaz, Ota
Aschermann, Michael
Jarkovsky, Jiri
Želízko, Michael
Kala, Petr
Groch, Ladislav
Svoboda, Michal
Hromadka, Milan
Widimsky, Petr
author_sort Motovska, Zuzana
collection PubMed
description BACKGROUND: Sex- and gender-associated differences determine the disease response to treatment. AIM: The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. METHODS AND RESULTS: We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03–3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0–2.23]), and also for an optimal procedural result (4.24 [2.12–8.49], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17–0.91], p = 0.029). CONCLUSION: The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.
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spelling pubmed-98457162023-01-19 Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials Motovska, Zuzana Hlinomaz, Ota Aschermann, Michael Jarkovsky, Jiri Želízko, Michael Kala, Petr Groch, Ladislav Svoboda, Michal Hromadka, Milan Widimsky, Petr Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Sex- and gender-associated differences determine the disease response to treatment. AIM: The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. METHODS AND RESULTS: We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03–3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0–2.23]), and also for an optimal procedural result (4.24 [2.12–8.49], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17–0.91], p = 0.029). CONCLUSION: The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services. Frontiers Media S.A. 2023-01-04 /pmc/articles/PMC9845716/ /pubmed/36684569 http://dx.doi.org/10.3389/fcvm.2022.953567 Text en Copyright © 2023 Motovska, Hlinomaz, Aschermann, Jarkovsky, Želízko, Kala, Groch, Svoboda, Hromadka and Widimsky. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Motovska, Zuzana
Hlinomaz, Ota
Aschermann, Michael
Jarkovsky, Jiri
Želízko, Michael
Kala, Petr
Groch, Ladislav
Svoboda, Michal
Hromadka, Milan
Widimsky, Petr
Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials
title Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials
title_full Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials
title_fullStr Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials
title_full_unstemmed Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials
title_short Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials
title_sort trends in outcomes of women with myocardial infarction undergoing primary angioplasty—analysis of randomized trials
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9845716/
https://www.ncbi.nlm.nih.gov/pubmed/36684569
http://dx.doi.org/10.3389/fcvm.2022.953567
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