Search Results (385)

Background/Objectives: Intravenous thrombolytic therapy remains the cornerstone of managing acute ischemic stroke (AIS) patients. Given the potential adverse effects of thrombolysis, patients are admitted to an intensive care unit (ICU) for close monitoring following administration. Alternative post-thrombolytic pathways may provide safe, cost-effective care in certain populations. We aimed to determine the proportion of patients treated with thrombolytics who required ICU care for reasons other than frequent neurologic monitoring and to define their characteristics. Methods: We retrospectively (May 2020–August 2022) reviewed patients ≥ 18 years of age who received Tenecteplase (TNK) or tissue plasminogen activator (tPA) for AIS at our stroke center. Patients were classified as requiring ICU care if they required intubation within 24 h of admission, required neurosurgical intervention, had symptomatic hemorrhagic conversion or brain compression, required a continuous infusion for hemodynamic management, or were in status epilepticus. Univariate and multivariable statistical analyses were performed. The study protocol was deemed exempt by our Institutional Review Board. Results: 262 patients met inclusion criteria. A total of 54 (20.6%) required ICU care. Multivariable analysis showed that patients on antithrombotic therapies prior to arrival (AOR: 3.344, p = 0.002) or who presented with higher initial NIH stroke scale (AOR: 1.116, p < 0.001) had a significantly higher likelihood of requiring an ICU level of care. Conclusions: In our cohort, approximately 21% of patients required critical care. Antithrombotic therapy before admission and greater NIH stroke scale on arrival were associated with an increased likelihood of requiring ICU care. Further prospective studies are indicated to assess the efficacy of alternative settings for post-thrombolytic care in selected AIS patients; however, our findings suggest that a specific subset of patients with AIS can be safely and effectively cared for in a non-ICU setting. This may have implications for the provision of safe, effective care while optimizing healthcare resource utilization. Full article

Objective: This study aimed to assess the association between the histopathological characteristics of thrombi extracted during endovascular thrombectomy and clinical factors, including the location of the occlusion, comorbid conditions, and treatment effectiveness, in patients with acute ischemic stroke. Materials and Methods: A total of 57 patients with acute ischemic stroke who underwent endovascular thrombectomy between 1 January 2022 and 31 December 2024 were included in the study. Thrombi were analyzed histopathologically and classified into categories based on their composition (RBC-dominant, fibrin-dominant, RBC = fibrin, organized fibrin) and phase (early or late stage). CD34 staining was used to assess organized fibrin. Results: The mean age of the patients was 65.2 ± 15.3 years, 52.6% were female, and 47.4% were male. The majority of thrombi were retrieved from the MCA M1 segment (64.9%). Histopathological analysis revealed that 49.1% of thrombi were RBC-dominant, 21.1% RBC = fibrin, 19.3% fibrin-dominant, and 10.5% contained organized fibrin. Early-stage thrombi accounted for 70.2% of cases, while late-stage thrombi comprised 29.8%. Thrombus composition was significantly associated with anatomical location, with RBC-dominant thrombi being most prevalent in the proximal ICA (88.2%; p < 0.001). CD34 staining identified organized fibrin in 10.5% of thrombi, exclusively in patients who underwent stent placement. However, no statistically significant correlation was identified between CD34 positivity and thrombus composition (p > 0.05). Additionally, no notable associations were found between thrombus composition and chronic comorbidities. Conclusions: Thrombus composition and stage exhibit variability depending on anatomical location, particularly in the proximal ICA, where RBC-dominant thrombi are more frequent. Although CD34 positivity indicates organized fibrin, it does not show a significant relationship with thrombus characteristics or patient comorbidities. These findings underscore the complex interplay between thrombus histopathology, anatomical location, and procedural outcomes, highlighting the need for further investigation. Full article

Background: Ischemic stroke remains a leading cause of mortality and long-term disability worldwide. Reperfusion therapies, such as intravenous thrombolysis and mechanical thrombectomy, are crucial for restoring cerebral blood flow but may also trigger ischemia–reperfusion injury and systemic inflammatory activation, associated with poorer clinical outcomes. Methods: We retrospectively analyzed medical records of 8833 patients hospitalized for acute ischemic stroke between January 2014 and May 2025. Of these, 2242 (25.38%) underwent reperfusion therapy (mechanical thrombectomy ± intravenous thrombolysis), and 6591 (74.62%) were treated conservatively. Laboratory parameters, including leukocyte count, C-reactive protein (CRP), and albumin, and composite inflammatory indices (e.g., neutrophil-to-lymphocyte ratio (NLR), systemic immune–inflammation index (SII), systemic-inflammation response index (SIRI), and neutrophil percentage-to-albumin ratio (NPAR)), were assessed at admission. Clinical outcomes included in-hospital mortality and functional scale results (e.g., National Institutes of Health Stroke Scale, modified Rankin score (mRS), Barthel scale, and Glasgow Coma Scale (GCS)). Results: Patients treated with reperfusion therapy had higher inflammatory indices (white blood cells, CRP, NLR, SII, and NPAR) compared to patients treated conservatively. In multiple regression analysis, these indices were significantly determined only by GCS and mRS scores, but age, gender, comorbidities, biochemical determinations, and type of ischemic stroke treatment (reperfusion or conservative) remained non-statistically significant. Conclusions: Patients with acute ischemic stroke undergoing reperfusion therapy exhibited a stronger inflammatory response and higher in-hospital mortality than those treated conservatively. However, multivariate analysis showed that a stronger inflammatory response following reperfusion therapy results more from the severity of the patients’ state than the kind of therapy. Full article

Background/Objectives: Post-varicella arteriopathy (PVA) is a significant cause of pediatric arterial ischemic stroke (AIS) that typically involves previously healthy children within 12 months of primary varicella infection, mostly with a monophasic course. Diagnosis is based on clinical and imaging findings, and cerebrospinal fluid analysis may confirm it; treatment is empirical and heterogeneous. We describe a typical case of PVA and present a systematic review of its clinical, radiological, therapeutic, and outcome features. Methods: Following PRISMA 2020 and AMSTAR-2 guidelines, data on demographics, clinical presentation, imaging, laboratory confirmation, treatment, and outcomes were extracted across databases (PubMed, Embase, Scopus). Results: Forty-seven studies, encompassing 312 pediatric patients, were included. Mean age was 4 years with a median latency of 3.82 months from varicella to neurologic symptoms. Common presentation included hemiparesis, language impairment, and seizures. Imaging findings showed unilateral focal involvement of anterior circulation arteries, basal ganglia infarctions, and, rarely, bilateral or posterior circulation involvement. CSF VZV-DNA PCR and anti-VZV IgG were positive in 39% and 48% of tested patients. Treatment included intravenous acyclovir (34%), corticosteroids (20%), and low-dose aspirin (77%); two patients underwent acute reperfusion therapy (rt-PA or thrombectomy). Outcomes tended to be moderately favorable: 43% achieved full recovery, 45% had residual deficit, and 11% experienced recurrence. Prothrombotic state was reported, and it may influence disease severity. Conclusions: PVA is a rare distinct cause of pediatric stroke, with a generally favorable prognosis quoad vitam. Standardized guidelines and prospective studies are needed to establish evidence-based management. Clinicians should maintain a high suspicion for its diagnosis. Full article

Background: Inflammatory bowel disease (IBD) is associated with systemic inflammation and potential cardiovascular complications. This meta-analysis evaluates long-term cardiovascular risks in IBD. Methods: Electronic databases were searched for studies examining cardiovascular, cerebrovascular, and thromboembolic risks in IBD. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Fifty-three studies comprising 1,406,773 patients were analyzed. IBD was linked to increased risk of ischemic heart disease (aHR 1.25; p = 0.001) myocardial infarction (aHR 1.25; p = 0.01), acute coronary syndrome (aHR 1.43; p < 0.00001), heart failure (aHR 1.24; p < 0.00001), atrial fibrillation (aHR 1.20; p < 0.00001), and stroke (aHR 1.13; p < 0.00001). Elevated risks were also observed for peripheral arterial disease (aHR 1.41; p < 0.00001), diabetes mellitus (aHR 1.40; p < 0.00001), venous thromboembolism (aHR 1.98; p < 0.00001), deep vein thrombosis (aHR 2.85; p = 0.0004), and pulmonary embolism (aHR 1.98; p = 0.03). Importantly, IBD was associated with increased cardiovascular (aHR 1.14; p = 0.03) and all-cause mortality (aHR 1.53; p < 0.00001). Conclusions: IBD patients face higher risk for adverse cardiovascular outcomes, thromboembolic disease, and mortality, necessitating early cardiovascular risk assessment and targeted interventions in this population. Full article

Background/Objectives: This study aimed to evaluate the ability of ChatGPT-5, a multimodal large language model, to perform automated ASPECTS assessment on non-contrast CT (NCCT) in patients with acute ischemic stroke. Methods: This retrospective, single-center study included 199 patients with anterior circulation AIS who underwent baseline NCCT before reperfusion therapy between November 2020 and February 2025. Each NCCT was evaluated by two human readers and by ChatGPT-5 using four representative images (two ganglionic and two supraganglionic). Interobserver agreement was measured with the intraclass correlation coefficient (ICC), and prognostic performance was analyzed using multivariable logistic regression and receiver operating characteristic (ROC) analysis for 3-month functional independence (mRS ≤ 2). Results: ChatGPT-5 demonstrated good-to-excellent agreement with expert consensus (ICC = 0.845; 95% CI, 0.792–0.884; κ = 0.79). ChatGPT-ASPECTS were independently associated with 3-month functional independence (OR = 1.28 per point; p = 0.004), comparable to consensus-ASPECTS (OR = 1.31; p = 0.003). Prognostic discrimination was similar between ChatGPT-5 and consensus scoring (AUC = 0.78 vs. 0.80; p = 0.41). Conclusions: ChatGPT-5 achieved high reliability and strong prognostic validity in automated ASPECTS assessment without task-specific training. These findings highlight the emerging potential of large language models for quantitative image interpretation, though clinical implementation will require multicenter validation and regulatory approval. Full article

Background: Endovascular therapy (EVT) is a standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO), but inter-hospital transfers from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) can result in delayed treatment and worse outcomes. Up to 30–40% of patients transferred may not receive EVT. This study investigates the causes of futile transfers to a CSC in Canada, aiming to identify its predictors. Methods: We conducted a retrospective analysis of consecutive patients transferred for EVT between 1 April 2017 and 31 December 2020, from PSCs and community hospitals (CH) to a CSC in an urban area of Canada. Data on demographics, clinical characteristics, and treatment outcomes were collected. Descriptive and comparative analyses were performed to identify factors contributing to non-receipt of EVT. Results: Of the transferred 326 patients, 241 (73.9%) underwent EVT, and 85 (26%) did not. The main reasons for not performing EVT were recanalization of the target vessel (44.7%), infarct growth (29.4%), clinical improvement or low NIHSS (17.6%), and hemorrhagic transformation (8.2%). Predictors of futility were lower NIHSS at presentation, intravenous thrombolysis (IVT) at the PSC, and greater ASPECTS decay during transport. Conclusions: Our study concluded that 26% of inter-hospital transfers for EVT were futile, primarily due to infarct growth, recanalization of the target vessel, and low NIHSS. These findings suggest that closer monitoring of clinical status, consideration of direct transfers to CSCs, and enhanced triage strategies may help reduce futile transfers and improve patient outcomes. Full article

Background: Anti-N-methyl-D-aspartate IgM and IgA antibodies (NMDAR1-abs) are associated with unfavorable stroke outcomes and may be risk factors thereof. However, to utilize NMDAR1-abs serostatus for risk assessment in acute stroke, it is crucial to understand the robustness of serostatus during this phase. Therefore, we investigated the robustness of NMDAR1-abs serostatus and titer levels up to seven days after stroke. Methods: In this exploratory analysis of the multicenter STRAWINSKI trial (identifier: NCT01264549), patients with severe ischemic stroke (NIHSS ≥ 9) in the middle cerebral artery territory were included. The first blood sample was taken within 36 h and then daily from day two to seven after stroke. NMDAR1-abs immunoglobulin (Ig)A and IgM were assessed in serum using cell-based assays. We initially measured NMDAR1-abs in the total cohort on day 1. Subsequently, in samples from seropositive and matched seronegative patients, we measured NMDAR1-abs on each following day. Titer dilutions started from 1:10 up to 1:1000. Seropositivity was defined as any titer > 0. Results: Out of 171 patients (mean age = 76 [SD = 11], median NIHSS = 15 [IQR = 12–18]), 16 (9%) individuals were seropositive. Seropositive patients remained seropositive and matched seronegative participants remained seronegative over sequential measurements. Although titer levels remained largely unchanged, some patients showed fluctuating titers. Conclusions: The status of NMDAR1-abs seropositivity is stable during acute stroke, with little to no variation in titer levels. Full article

Background/Objectives: The optimal timing for initiating oral anticoagulants (OACs) after acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) remains uncertain due to potential risks of recurrent stroke and bleeding. This meta-analysis compares early versus late OAC initiation for recurrent ischemic stroke, major bleeding, intracranial hemorrhage (ICH), systemic embolism, and all-cause mortality. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs), prospective, and retrospective observational studies. Data were pooled using random-effects models, and subgroup analyses were performed to assess outcomes by study design. Heterogeneity was quantified using I² statistics. Results: A total of 17 studies were included. Early OAC initiation was associated with a significantly lower risk of recurrent ischemic stroke compared to late initiation (OR = 0.74, 95% CI [0.58, 0.95], p = 0.02), with moderate heterogeneity (I² = 36%, p = 0.08). No significant difference was observed in ICH rates (OR = 0.74, 95% CI [0.41, 1.33], p = 0.32), major bleeding (OR = 1.48, 95% CI [0.51, 4.30], p = 0.47), or systemic embolism (OR = 0.65, 95% CI [0.33, 1.25], p = 0.20). All-cause mortality showed no difference between early and late initiation (OR = 1.00, 95% CI [0.72, 1.39], p = 0.99). Subgroup analyses were consistent with overall findings, and heterogeneity ranged from low to moderate across outcomes. Conclusions: Early initiation of OACs post-AIS in AF patients significantly reduces ischemic stroke recurrence without increasing risks of ICH, major bleeding, systemic embolism, or mortality. These findings support early anticoagulation strategies for selected patients. Full article

Introduction: Epicardial adipose tissue (EAT), a fat depot between the myocardium and pericardium, produces pro-inflammatory adipokines, contributing to inflammation, insulin resistance, and endothelial dysfunction. EAT has been recognized as an independent risk factor for cardiovascular diseases, including atrial fibrillation (AFib) and acute ischemic stroke (AIS). This study explores the association between EAT and AIS risk, with a focus on populations with cardiovascular comorbidities. Material and Methods: This meta-analysis adhered to MOOSE and PRISMA guidelines. A comprehensive search of PubMed, SCOPUS, and Embase databases was conducted, targeting studies evaluating the association between EAT and AIS. Inclusion criteria encompassed RCTs, cohort, case–control, and cross-sectional studies. Quality assessment was performed using appropriate tools, and statistical analysis involved pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a binary random-effects model. Results: The search identified 711 studies, eight of which met the inclusion criteria, yielding 7412 participants. Analysis revealed that increased EAT thickness significantly correlated with higher odds of AIS (aOR: 3.60 [2.26–5.74], I² = 74.24%). Sensitivity analysis confirmed the robustness of these findings despite publication bias. Higher epicardial adipose volume was also associated with an increased AIS risk (aOR: 1.17 [1.03–1.34], I² = 49.54%). Conclusions: Increased EAT thickness and volume are associated with a higher risk of AIS in populations with cardiovascular comorbidities, including AFib. EAT’s pro-inflammatory and pro-thrombotic properties may contribute to stroke pathophysiology. These findings highlight the potential utility of EAT measurement in stroke risk stratification and support further research to integrate EAT assessment into clinical practice. Full article

Background: The early and accurate classification of ischemic stroke stages on computed tomography (CT) remains challenging due to subtle attenuation differences and significant scanner variability. This study developed a neural network framework to dynamically optimize Hounsfield Unit (HU) transformations and CLAHE parameters for temporal stage-specific stroke classification. Methods: We analyzed 1480 CT cases from 68 patients across five stages (hyperacute, acute, subacute, chronic, and normal). The training data were augmented via horizontal flipping, ±7° rotation. A convolutional neural network (CNN) was used to optimize linear transformation and CLAHE parameters through a combined loss function incorporating the effective measure of enhancement (EME), peak signal-to-noise ratio (PSNR), and regularization. the enhanced images were classified using logistic regression (LR), support vector machines (SVMs), and random forests (RFs) with 25-fold cross-validation. Model interpretability was evaluated using Grad-CAM. Results: Neural network optimization significantly outperformed static parameters across validation metrics. Deep CLAHE achieved the following accuracies versus static CLAHE: hyperacute (0.9838 vs. 0.9754), acute (0.9904 vs. 0.9873), subacute (0.9948 vs. 0.9825), and chronic (near-perfect 0.9979 vs. 0.9808). Qualitative interpretability analysis confirmed that models focused on clinically relevant regions, with optimized enhancement producing more coherent attention patterns than static methods. Parameter analysis revealed stage-aware adaptation: conservative enhancement in early phases (slope: 1.249–1.257), maximized in subacute (slope: 1.290–1.292), and restrained in the chronic phase (slope: 1.240–1.258), reflecting underlying stroke pathophysiology. Conclusions: A neural network-optimized framework with interpretability validation provides stage-specific stroke classification that achieves superior performance over static methods. Its pathophysiology-aligned parameter adaptation offers a clinically viable and transparent solution for emergency stroke assessment. Full article

The blood–brain barrier (BBB) represents a major challenge in effective drug delivery systems intended for treating neurological disorders. It restricts the transport of therapeutic agents to the brain. Chitosan-based nanoparticles (CNPs) can be used for brain drug delivery because of their biocompatibility, biodegradability, and ability to enhance drug permeability across the BBB. This review article discusses the design and application of CNPs for brain-targeted drug delivery, exploring their mechanisms of action, including adsorptive-mediated and receptor-mediated endocytosis. Surface modifications with ligands such as chlorotoxin are discussed for improving specificity and therapeutic results. Findings show that CNPs allow controlled drug release, enhance stability, and reduce side effects, which make them effective for treating multiple neurological conditions, including Alzheimer’s disease, Parkinson’s disease, brain tumors, and ischemic stroke. CNPs can encapsulate multiple therapeutic agents, such as anti-inflammatory drugs, cytotoxic agents, and genetic materials, and maintain stability under different physiological conditions. Intranasal delivery routes are mainly discussed in this paper for their ability to bypass systemic circulation and achieve direct brain targeting. This review also addresses challenges such as cytotoxicity and the need for optimizing nanoparticle size, charge, and surface properties to improve the therapy results. While CNPs are suitable for brain drug delivery, there is a research gap, which is the lack of systematic studies evaluating their long-term effects on brain tissue and health. Most studies focus on acute therapeutic outcomes and in vitro or short-term in vivo analysis, which do not address some questions about the chronic exposure risks, biodistribution, and clearance pathways of CNPs. This review also explores the use of chitosan-based nanoparticles to deliver drugs to the brain for the treatment of multiple neurological disorders. Full article

Background: The management of acute ischemic stroke (AIS) in anticoagulated patients presents a clinical challenge, as concerns about safety and efficacy often limit access to recanalization therapies. Despite the widespread use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), their impact on functional recovery and mortality following intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) remains uncertain. Therefore, this study investigates the association between prior anticoagulation and 90-day outcomes in AIS patients undergoing reperfusion therapy. Methods: We conducted a retrospective cohort analysis using our institutional stroke registry, including AIS patients admitted to the Department of Neurology at our university between February 2023 and 2025. Anticoagulated patients were 1:1 propensity score-matched with non-anticoagulated controls (n = 126 per group) using Mahalanobis distance matching with a caliper, adjusting for age, sex, hypertension, diabetes, stroke severity (National Institutes of Health Stroke Scale [NIHSS] at admission and 72 h), and pre-stroke functional status (pre-morbid modified Rankin Scale [pre-mRS]). Primary endpoints at 90 days were functional independence (modified Rankin Scale [mRS] ≤ 2), mRS-shift, and mortality (mRS = 6). Predictors of outcome were assessed using multivariable logistic regression and generalized additive models (GAMs). Subgroup analyses evaluated the effects of anticoagulation type and treatment modality. Results: Among 866 AIS patients (DOAC n = 100, VKA n = 48, non-anticoagulated n = 718), 426 (49.2%) underwent reperfusion therapy (IVT n = 195, MT n = 163, IVT + MT n = 68). Before matching, anticoagulated patients were less likely to achieve functional independence (34.5% vs. 52.1%, odds ratio [OR] = 0.48, 95% confidence interval [CI] [0.33–0.70], p < 0.001), had a greater mRS-shift (2.53 vs. 1.79, p < 0.001), and higher mortality (30.4% vs. 14.5%, OR = 2.58, 95% CI [1.72–3.88], p < 0.001). However, after matching, these differences were no longer statistically significant. NIHSS, 72hNIHSS, and pre-mRS were the strongest independent predictors of outcome (p < 0.001), while anticoagulation status had no significant effect. Conclusions: Recanalization therapy was not associated with worse functional outcomes in selected anticoagulated AIS patients. These findings suggest that prior anticoagulation alone should not preclude reperfusion therapy in otherwise eligible patients, and underscore the importance of individualized, evidence-based decision-making in acute stroke care. Full article

Background: Dual antiplatelet therapy (DAPT), combining aspirin with a P2Y12 receptor inhibitor (P2Y12i), remains central to the management of acute myocardial infarction (MI), especially in patients undergoing percutaneous coronary intervention (PCI). However, the pharmacodynamic response to antiplatelet therapy may vary with body composition. This study investigates the association between body mass index (BMI) and clinical outcomes in MI patients treated with PCI and DAPT. Methods: This retrospective cohort study analyzed data from 52,119 MI patients treated with coronary stenting from 2014 to 2021, sourced from the Hungarian Myocardial Infarction Registry. Patients were stratified into clopidogrel-based (n = 44,480) and potent P2Y12i-based (prasugrel or ticagrelor; n = 7639) DAPT cohorts. Clinical outcomes—including 12-month mortality and ischemic events—were assessed across BMI categories. Kaplan–Meier analysis and LASSO Cox regression identified predictors of mortality, while decision curve analysis (DCA) evaluated the net clinical benefit of potent P2Y12i across BMI strata. Results: Univariate and multivariate Cox regression analyses identified BMI and potent P2Y12i treatment as significant predictors of 365-day mortality, with higher BMI associated with lower observed rates of mortality, major adverse cardiovascular events (MACEs), and stroke. However, higher BMI was also associated with an increased risk of repeat revascularization and PCI. This study found that the protective effect of potent P2Y12i treatment was consistent across different BMI categories. Conclusions: In patients with MI undergoing PCI, elevated BMI was paradoxically associated with more favorable short-term outcomes, including reduced mortality. Potent P2Y12i therapy demonstrated a consistent benefit across BMI categories, supporting its broad application irrespective of body mass. Full article

Background/Objectives: Traditionally, women have been observed to have older age, more co-morbidities, and poorer long-term clinical outcomes following acute myocardial infarction (AMI) when compared to men. However, age-adjusted analyses have demonstrated that gender differences are often attenuated, and the potential influence of left ventricular function and structure have been infrequently studied. The aim of the present study was to evaluate how LV function could influence gender differences in the long-term incidence of a composite of clinically relevant cardiovascular outcomes. Methods: Patients treated with early PCI for AMI were examined with echocardiography 2–4 days after the index AMI and followed by a mean 73 (±13) months. The primary endpoint was the incidence of a composite of total death, recurrent myocardial infarction, hospitalization for angina pectoris with an angiogram documenting progression of coronary artery stenoses, new heart failure, evidence of stroke/transient ischemic attack (TIA), and ventricular arrhythmia. Results: Among the 236 patients studied, 179 (76%) were men, with an average age of 66 (±11) years, and 57 were women (24%), with an age of 65 (±10) years. Men exhibited a higher incidence of anterior STEMI (p = 0.030), lower left ventricular ejection fraction (LVEF) (p = 0.02), reduced global longitudinal strain (p = 0.001), and larger left ventricular end-systolic volume index (LVESVI) (p = 0.007) compared to women. Both genders had similar peak troponin T values and symptom-to-needle times, as well as an equivalent number of stents implanted, prevalence of co-morbidities, and discharge medication. After sixyears of follow-up, Kaplan–Meier curves revealed better long-term cardiovascular outcome-free survival among women (log-rank p = 0.041). Cox regression analysis indicated that neither age nor LVEF influenced this gender difference, which, however, was reduced and became non-significant when LVESVI was added (HR 1.747 (95% CI 0.89–3.43)). No difference in mortality was observed, but men had significantly higher rates of heart failure (p = 0.03). Conclusions: This study demonstrated that men with a previous PCI-treated AMI had a two-fold (HR 2.155) higher risk of a composite long-term cardiovascular outcome as compared with women. The detrimental effect of male gender remained significant after adjustments for age and LVEF, but the male gender effect was reduced and became insignificant after adjustment for age and LVESVI. In view of this, our findings indicate that higher LVESVI may partly explain the detrimental effect of male gender on cardiovascular outcomes after PCI-treated AMI. Full article