1. Mortality in women undergoing primary PCI for STEMI Observations from the Lehigh Valley Hospital Health Network MI Alert Program 2007 Bruce Feldman, J. Patrick Kleavland, David Cox, Richard MacKenzie, David Richardson, Jeffrey Snyder, Gerald Pytlewski, Dzanan Ramic, James Reed, Michael Rossi. Lehigh Valley Hospital, Allentown, Pa.

2. BACKGROUND: Women with acute MI undergoing PCI have been reported to have a higher mortality rate than men. OBJECTIVE: Document the mortality rate of women and men with acute STEMI who underwent primary PCI. METHODS: Retrospective review of 578 patients undergoing primary PCI for acute STEMI from 4/2004 – 5/2007.

3. Mortality after primary PCI for STEMI Impact of Age and Gender AGEFEMALEMALEP value < 65 (349)* 1.4%0% 65-80 (179)* 6.7%1.9% > 80 (50)* 19.4%3.3% TOTAL 2.4% 6.8% 0.7% < 0.004 * Number of patients in category

4. Impact of gender in the elderly (>80 yrs) FEMALE MALE Number 2723 Age (mean) 85 median D2B -Local (mins) -Regional (mins) 81 118 92 144 CHF (%) 3035 Systolic BP < 100 (%) 1122 Mortality (%) 19.43.3

5. Impact of gender in the elderly (>80 yrs) FEMALE MALE Number 2723 Age (mean) 85 median D2B -Local (mins) -Regional (mins) 81 118 92 144 CHF (%) 197 Systolic BP < 100 (%) 103 Mortality (%) 19.43.3

6. LIMITATIONS –Small sample size –Symptom onset and total ischemic time not assessed.

7. CONCLUSIONS –Women with acute STEMI have a higher mortality rate than men. – Elderly women with acute STEMI have a particularly high mortality rate. –Symptom onset to balloon time (total ischemic time) as well as other predictors of mortality should be considered when evaluating mortality following acute MI.

8. Mortality after primary PCI for STEMI Impact of Age and Gender AGEFEMALEMALE < 65 (349)* 1.4% (1/71)* 0% (0/278)* 65-80 (179)* 6.7% (4/60)* 1.9% (2/106)* > 80 (50)* 19.4% (6/31)* 3.3% (1/29)* TOTAL (578)* 6.8% (11/162)* 0.7% (3/416)* * Number of patients in category

9. Elderly with Cardiogenic Shock SHOCK TRIAL NEJM 1999 341 625 Age < 75 - 1 year mortality was 54% with emergency revascularization versus 69% with initial medical stabilization. Age > 75 (N = 56) - When compared to conservative medical treatment, there was no benefit to immediate revascularization with PCI or CABG. Mortality at 6 months was 66%. At 1 year ? Age > 75 in the SHOCK REGISTRY (nonrandomized), those receiving emergency revascularization had a better outcome.

10. High Risk and Low Benefit Age > 85 Age > 75 PLUS –Shock or Killip Class IV (systolic BP < 90 and pulmonary edema) AND –Functional Class IV and/or comorbidity associated with life expectancy < 1year.

11. Fig 2 JACC 2005 45 473 PCI in elderly