Document Detail


Relationship of female sex to outcomes after myocardial infarction with persistent total occlusion of the infarct artery: analysis of the Occluded Artery Trial (OAT).
MedLine Citation:
PMID:  22424018     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Long-term follow-up (up to 9 years) from the OAT allows for the examination of sex differences in outcomes and the effect of percutaneous coronary intervention (PCI) in a relatively homogeneous cohort of myocardial infarction (MI) survivors.
METHODS: The OAT randomized 484 (22%) women and 1717 men to PCI of the occluded infarct-related artery vs medical therapy alone >24 hours post-MI. There was no benefit of PCI on the composite of death, MI, and class IV heart failure. We analyzed outcomes by sex and investigated for sex-based trial selection bias using a concurrent registry.
RESULTS: Women were older and more likely to have left anterior descending infarct-related artery, diabetes and hypertension, history of heart failure, and rales at randomization but were less likely to smoke. The proportion and characteristics of women enrolled in the trial and the registry were similar, including left ventricular ejection fraction and extent of disease. Women had higher rates of the primary composite (hazard ratio [HR] 1.48, P = .0002), death (HR 1.50, P = .001), and heart failure (HR 2.53, P < .0001) but not reinfarction (HR 1.12, P = .57). Female sex was not independently associated with the primary end point or death on multivariate analysis. There was a trend toward independent association of female sex with heart failure (HR 1.66, P = .02).
CONCLUSION: Women in OAT had a higher primary end point event rate than did men, mainly driven by heart failure. Female sex was not independently associated with death or MI in this well-defined cohort with comparable extent of coronary artery disease, similar medical therapy, and equivalent left ventricular ejection fraction by sex.
Authors:
Harmony R Reynolds; Sandra A Forman; Jacqueline E Tamis-Holland; Philippe Gabriel Steg; Daniel B Mark; Camille A Pearte; Antonio C Carvalho; George Sopko; Li Liu; Gervasio A Lamas; Mariusz Kruk; Krystyna Loboz-Grudzien; Witold Ruzyllo; Judith S Hochman
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American heart journal     Volume:  163     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-19     Completed Date:  2012-05-15     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  462-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
Affiliation:
Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, USA. harmony.reynolds@nyumc.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary*
Coronary Stenosis / complications*,  therapy
Female
Follow-Up Studies
Heart Failure / epidemiology*,  etiology
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / complications,  epidemiology,  therapy*
Sex Factors
Survival Rate / trends
Time Factors
United States / epidemiology
Grant Support
ID/Acronym/Agency:
L30 HL075107-02/HL/NHLBI NIH HHS; U01 HL062257/HL/NHLBI NIH HHS; U01 HL062509/HL/NHLBI NIH HHS; U01 HL062511/HL/NHLBI NIH HHS
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