Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction
Objectives We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).Methods Patients with STEMI undergoing emergency percutaneous coronary intervention (...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-05-01
|
| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/6/1/e000979.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850191628593004544 |
|---|---|
| author | Mark C Petrie Naveed Sattar Colin Berry Kenneth Mangion Annette Marie Maznyczka David Carrick Jaclyn Carberry Margaret McEntegart Hany Eteiba Mitchell Lindsay Stuart Hood Stuart Watkins Andrew Davie Ahmed Mahrous Ian Ford Paul Welsh Keith G Oldroyd |
| author_facet | Mark C Petrie Naveed Sattar Colin Berry Kenneth Mangion Annette Marie Maznyczka David Carrick Jaclyn Carberry Margaret McEntegart Hany Eteiba Mitchell Lindsay Stuart Hood Stuart Watkins Andrew Davie Ahmed Mahrous Ian Ford Paul Welsh Keith G Oldroyd |
| author_sort | Mark C Petrie |
| collection | DOAJ |
| description | Objectives We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).Methods Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up.Results In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation.Conclusion There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women.Trial registration number NCT02072850. |
| format | Article |
| id | doaj-art-cd21c15cdcd84bfdb5865ed734206378 |
| institution | OA Journals |
| issn | 2053-3624 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-cd21c15cdcd84bfdb5865ed7342063782025-08-20T02:14:50ZengBMJ Publishing GroupOpen Heart2053-36242019-05-016110.1136/openhrt-2018-000979Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarctionMark C Petrie0Naveed Sattar1Colin Berry2Kenneth Mangion3Annette Marie Maznyczka4David Carrick5Jaclyn Carberry6Margaret McEntegart7Hany Eteiba8Mitchell Lindsay9Stuart Hood10Stuart Watkins11Andrew Davie12Ahmed Mahrous13Ian Ford14Paul Welsh15Keith G Oldroyd16School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UKSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland27 BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UKSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UKBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K, Glasgow, UK2University of Glasgow2University of Glasgow2 West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK1Golden Jubilee National Hospital, Golden Jubilee National Hospital, Agamemnon St, Clydebank, Glasgow, GLG G81 4DY, UK1Golden Jubilee National Hospital, Golden Jubilee National Hospital, Agamemnon St, Clydebank, Glasgow, GLG G81 4DY, UK2University of Glasgow1Golden Jubilee National Hospital, Golden Jubilee National Hospital, Agamemnon St, Clydebank, Glasgow, GLG G81 4DY, UKBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UKBritish Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK2University of Glasgow1University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United KingdomBiosensors Europe SA, Morges, SwitzerlandObjectives We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).Methods Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up.Results In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation.Conclusion There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women.Trial registration number NCT02072850.https://openheart.bmj.com/content/6/1/e000979.full |
| spellingShingle | Mark C Petrie Naveed Sattar Colin Berry Kenneth Mangion Annette Marie Maznyczka David Carrick Jaclyn Carberry Margaret McEntegart Hany Eteiba Mitchell Lindsay Stuart Hood Stuart Watkins Andrew Davie Ahmed Mahrous Ian Ford Paul Welsh Keith G Oldroyd Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction Open Heart |
| title | Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction |
| title_full | Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction |
| title_fullStr | Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction |
| title_full_unstemmed | Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction |
| title_short | Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction |
| title_sort | sex based associations with microvascular injury and outcomes after st segment elevation myocardial infarction |
| url | https://openheart.bmj.com/content/6/1/e000979.full |
| work_keys_str_mv | AT markcpetrie sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT naveedsattar sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT colinberry sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT kennethmangion sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT annettemariemaznyczka sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT davidcarrick sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT jaclyncarberry sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT margaretmcentegart sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT hanyeteiba sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT mitchelllindsay sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT stuarthood sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT stuartwatkins sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT andrewdavie sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT ahmedmahrous sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT ianford sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT paulwelsh sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction AT keithgoldroyd sexbasedassociationswithmicrovascularinjuryandoutcomesafterstsegmentelevationmyocardialinfarction |