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Renal insufficiency linked to worse post-PCI prognosis in women than men
28 January 2011
MedWire News: Study results suggest that women with ST-elevation myocardial infarction (STEMI) are more likely to have renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2, than men.
”Renal insufficiency affects the dosage of many drugs and increases the risks of contrast-induced nephropathy and bleeding after percutaneous coronary intervention (PCI),” explain Sofia Lawesson (Linköping University Hospital, Sweden) and co-authors.
Therefore, women are also at higher risk for poor post-PCI and STEMI outcomes than men, they remark.
The study, published in the journal Heart, involved 274 male (n=176) and female (n=98) STEMI patients.
Lawesson and colleagues assessed all patients for the presence of renal insufficiency and found that many more women had renal insufficiency than men, at 67% versus 26%.
In women, each 10 ml/min/1.73 m2 improvement in eGFR was associated with significant reductions of 63% and 39% in the respective risks for death and adverse events at 1-year (confidence interval [CI]:0.15 to 0.89). In men, however, changes in eGFR did not significantly affect the 1-year mortality or major adverse cardiac event (MACE; death, nonfatal myocardial infarction, stroke, or new revascularization) risk.
The team used multivariable logistic regression analyses to detect interactions between gender and eGFR regarding 1–year mortality and MACE risk. In so doing, they found interactions of borderline significance between gender and eGFR regarding 1-year mortality but not 1-year MACE risk, with respective odds ratios of 2.05 (p=0.08) and 1.42 (p=0.11).
“Women have been shown to have 10%–20% higher odds of early mortality in STEMI even after adjustment for all kinds of possible confounders,” say Lawesson and team.
“Our findings of female sex being an independent strong predictor of renal insufficiency in STEMI patients and its possibly higher prognostic impact in women could be an important explanation for this observed sex difference,” they conclude.
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