Impact of gender differences on myocardial salvage and post-ischaemic left ventricular remodelling after primary coronary angioplasty: new insights from cardiovascular magnetic resonance

There is conflicting evidence on the impact of gender on reperfusion after primary coronary angioplasty (PPCI), and on left ventricular (LV) remodelling (LVR). In a cohort of patients with reperfused ST elevation myocardial infarction (STEMI), gender-related differences on myocardial reperfusion, and sex-related differences on LVR were assessed by using a comprehensive cardiac magnetic resonance (CMR) approach. In four tertiary referral centres, 283 (238 males and 45 females) consecutive STEMI patients, treated with PPCI within 12 h from symptoms onset underwent CMR 3 2 days after STEMI and at 4-month follow-up. By CMR, the area at risk, infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) were assessed. Women were older than men (P 0.014), more hypertensive (P 0.001) and more frequently presented with pre-infarct angina (P 0.018). An MSI extent was significantly higher (P 0.013), IS was significantly smaller at both time points (acute P 0.001, follow-up P 0.001), and the MVO extent was significantly smaller (P 0.001) in women. At multivariate analysis, Killip class and female sex were independently associated with a higher MSI (P 0.02, P 0.05, respectively). A similar incidence of LVR in both sexes was observed at follow-up (P 0.808). The better reperfusion pattern observed in women by CMR in our population of reperfused STEMI suggests sex-based differences exist. No gender differences were observed with respect to incidence of LV remodelling at the follow-up mainly occurring in the subset of patients with a larger IS.