Female gender: an independent factor in ST-elevation myocardial infarction
Joana Trigo1, Jorge Mimoso, Paula Gago
1Serviço de Cardiologia, Hospital de Faro, EPE, Faro, Portugal. jotrigo@gmail.com
Insights
Women with ST-elevation myocardial infarction (STEMI) face worse outcomes due to older age, higher risk, and delayed treatment. Female gender independently increases mortality risk in STEMI patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Gender-based Health Research
Background:
- Cardiovascular disease is a leading cause of mortality in women.
- The prognosis of ST-elevation myocardial infarction (STEMI) in women requires further investigation into gender-specific factors.
Purpose of the Study:
- To compare STEMI patients by gender regarding cardiovascular risk, clinical presentation, treatment, and mortality.
- To identify gender-based differences in STEMI patient outcomes.
Main Methods:
- Analysis of 1578 consecutive STEMI patients over 7 years (2002-2008).
- Comparison of male and female patients on demographics, risk factors, pre-hospital/in-hospital delays, clinical presentation, reperfusion therapy, and mortality.
- Multivariate analysis to adjust for confounding factors.
Main Results:
- Women constituted 26% of STEMI patients, were older, and had a higher cardiovascular risk profile.
- Women presented with more severe symptoms, including anterior MI and heart failure, experienced longer ischemic times, and received less reperfusion therapy.
- In-hospital (17.5% vs 5.3%) and 6-month (23.5% vs 8.2%) mortality rates were significantly higher in women, persisting after multivariate adjustment.
Conclusions:
- Adverse demographic and clinical profiles, along with longer delays, contribute to worse STEMI prognosis in women.
- Underuse of reperfusion therapy in women is linked to pre-hospital delays.
- Female gender independently confers a negative influence on STEMI patient mortality.
Introduction:
Cardiovascular disease is the leading cause of death in women. In ST-elevation myocardial infarction (STEMI) in particular, the question has been raised whether specific characteristics of women confer a worse prognosis.
Objective:
To evaluate the differences in STEMI patients between the genders in cardiovascular risk profile, clinical presentation, therapeutic approach and in-hospital and 6-month mortality rates.
Methods:
We analyzed 1578 patients admitted consecutively with STEMI during a 7-year period (from January 13, 2002 to December 31, 2008). The patients were divided into two groups according to gender, and compared in terms of baseline clinical and demographic characteristics, pre-hospital and in-hospital delay, clinical presentation on admission, reperfusion therapy, severity of coronary disease and in-hospital and 6-month mortality.
Results:
Of the 1578 patients, 26% were female. Women were older (by 8 years), and had a higher cardiovascular risk profile. On admission, their clinical presentation was more severe, with a higher frequency of anterior myocardial infarction and acute heart failure symptoms. Women had longer ischemic times and lower rates of reperfusion therapy. Mortality in women was significantly higher than in men, both in-hospital (17.5 vs. 5.3%) and at 6 months (23.5% vs. 8.2%). After adjustment in multivariate analysis, mortality in women remained higher.
Conclusions:
The adverse demographic and clinical profile could partially explain the worse prognosis of STEMI in women. This, together with longer pre-hospital delays, led to underuse of reperfusion therapy. Even so, female gender by itself had a negative and independent influence on mortality in STEMI patients.
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