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The clinical impact of sex differences on ischemic postconditioning during primary percutaneous coronary intervention: a POST (the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction) substudy

  • Eun-Seok Shin
  • Ju-Hyun Chung
  • Joo-Yong Hahn
  • Young Bin Song
  • Eun Kyoung Kim
  • Cheol Woong Yu
  • Jang-Whan Bae
  • Woo-Young Chung
  • Seung-Hyuk Choi
  • Jin-Ho Choi
  • Jang-Ho Bae
  • Kyung Joo An
  • Jong-Seon Park
  • Ju Hyeon Oh
  • Sang-Wook Kim
  • Jin-Yong Hwang
  • Jae Kean Ryu
  • Scot Garg
  • Do-Sun Lim
  • Hyeon-Cheol Gwon
  • Hun Sik Park
Original Article
  • 26 Downloads

Abstract

The POST (the effects of postconditioning on myocardial reperfusion in patients with ST-Segment elevation myocardial infarction) study showed that ischemic postconditioning did not improve myocardial reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, it has not been determined whether postconditioning is effective in women. This study sought to evaluate the impact of sex differences on ischemic postconditioning during the primary PCI. We analyzed clinical outcomes at 1 year in the 537 men and 163 women with STEMI, who were randomized to the postconditioning or to the conventional PCI group. Women were older, had higher rates of hypertension, were less likely to be current smokers, and had longer symptom-to-reperfusion time. The rate of major adverse cardiac events (MACE: a composite of death, myocardial infarction, severe heart failure, stent thrombosis, or target vessel revascularization) at 1 year was higher in women compared to men (9.8% vs. 5.4%, p = 0.044). MACE was significantly higher in women compared to men in the postconditioning group (12.2% vs. 5.4%, p = 0.042), but not in the conventional PCI group (7.9% vs. 5.4%, p = 0.391). However, women was not an independent predictor after adjusting baseline risk factors, angiographic and procedural parameters (HR 2.67, 95% CI 0.68–10.5, p = 0.158). Despite women having more adverse clinical characteristics, their prognosis was similar to men in the conventional group. Although women showed a higher rate of the MACE compared to men, women were not an independent predictor in the postconditioning group.

Keywords

Sex difference Ischemic postconditioning Myocardial infarction Percutaneous coronary intervention 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Eun-Seok Shin
    • 1
  • Ju-Hyun Chung
    • 1
  • Joo-Yong Hahn
    • 2
  • Young Bin Song
    • 2
  • Eun Kyoung Kim
    • 2
  • Cheol Woong Yu
    • 3
  • Jang-Whan Bae
    • 4
  • Woo-Young Chung
    • 5
  • Seung-Hyuk Choi
    • 2
  • Jin-Ho Choi
    • 2
  • Jang-Ho Bae
    • 6
  • Kyung Joo An
    • 7
  • Jong-Seon Park
    • 8
  • Ju Hyeon Oh
    • 9
  • Sang-Wook Kim
    • 10
  • Jin-Yong Hwang
    • 11
  • Jae Kean Ryu
    • 12
  • Scot Garg
    • 13
  • Do-Sun Lim
    • 3
  • Hyeon-Cheol Gwon
    • 2
  • Hun Sik Park
    • 14
  1. 1.Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanSouth Korea
  2. 2.Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  3. 3.Korea University Anam HospitalSeoulSouth Korea
  4. 4.Chungbuk National University HospitalCheongjuSouth Korea
  5. 5.Seoul National University Boramae Medical CenterSeoulSouth Korea
  6. 6.Konyang University HospitalDaejonSouth Korea
  7. 7.KEPCO Medical CenterSeoulSouth Korea
  8. 8.Yeungnam University HospitalDaeguSouth Korea
  9. 9.Samsung Changwon HospitalSungkyunkwan University School of MedicineChangwonSouth Korea
  10. 10.Chung-Ang University HospitalSeoulSouth Korea
  11. 11.Gyeongsang National University HospitalJinjuSouth Korea
  12. 12.Daegu Catholic University Medical CenterDaeguSouth Korea
  13. 13.East Lancashire Hospitals NHS TrustBlackburnUK
  14. 14.Kyungpook National University HospitalDaeguSouth Korea

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