[Comparison on therapeutic approach and short-term outcomes between male and female patients with ST-segment
Xing-hui Shao1, Yan-min Yang, Jun Zhu
1Department of Emergency and Intensive Care Center, Chinese Academy Medical Science, Beijing, China.
Insights
Female ST-elevation myocardial infarction (STEMI) patients experienced worse short-term outcomes and received less reperfusion therapy compared to males. These disparities are partly explained by their older age and more comorbidities, highlighting gender-specific care needs in STEMI treatment.
Area of Science:
- Cardiology
- Clinical Medicine
- Gender Health
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiovascular emergency.
- Understanding gender-specific differences in STEMI management and outcomes is crucial for improving patient care.
- Previous studies suggest potential disparities in treatment and prognosis between male and female STEMI patients.
Purpose of the Study:
- To investigate gender-related differences in therapeutic approaches and short-term outcomes among Chinese patients with STEMI.
- To identify demographic and clinical factors contributing to these observed gender disparities.
- To compare treatment strategies, including reperfusion and pharmacotherapy, and 30-day clinical endpoints between male and female STEMI patients.
Main Methods:
- Retrospective analysis of data from the CREATE clinical trial involving Chinese STEMI patients.
- Patients were stratified into male and female groups for comparative analysis.
- Key variables included demographics, baseline characteristics, reperfusion therapy, drug administration, and 30-day mortality, re-infarction, stroke, hemorrhage, and heart failure.
Main Results:
- Female STEMI patients were older, presented with higher heart rates, lower blood pressure, and longer delays to hospital arrival.
- Females had a higher prevalence of diabetes, hypertension, and heart failure, and were less likely to receive percutaneous coronary intervention (PCI).
- Female patients exhibited significantly higher 30-day all-cause mortality and combined adverse endpoints compared to males.
Conclusions:
- Significant gender-related differences exist in the therapeutic approach and short-term outcomes for Chinese STEMI patients.
- Unfavorable demographic and clinical profiles in female patients partially explain lower reperfusion rates and worse prognoses.
- Tailored treatment strategies considering gender-specific factors are warranted to improve outcomes for female STEMI patients.
Objective:
To compare the differences on therapeutic approach and short-term outcomes between male and female patients with ST-elevation myocardial infarction (STEMI).
Methods:
Data of Chinese STEMI patients were retrospectively analyzed from a global multicenter clinical trial of reviparin and metabolic modulation in acute myocardial infarction treatment evaluation (CREATE). The patients were divided into two groups according to gender and difference on demographic, baseline clinical characteristics at admission, reperfusion and drug therapy and 30-day all-cause mortality, re-infarction, stroke, hemorrhage, heart failure and combined end points were compared.
Results:
Of the 7431 patients, 29.1% were female. Female patients were older than male patients [(68.2 ± 9.1) years vs. (60.3 ± 12.1) years]. On admission, heart rate, diastolic blood pressure and Killip class were higher and the delay between onset of chest pain and arrival at hospital was longer in female patients than in male patients (all P < 0.01). Male patients often presented MI in anterior leads while female patients often presented MI in inferior and lateral leads. History of diabetes mellitus, hypertension and heart failure was significantly higher in female than in male patients (all P < 0.01). Incidence of high blood glucose was higher in female while high blood potassium was higher in male patients (P < 0.01). Rate of reperfusion therapy was lower and the use aspirin and diuretic was more frequent in female patients than in male patients, while frequency of clopidogrel, Glycoprotein IIb/IIIa receptor inhibitor, β-blockers, angiotensin converting enzyme inhibitor, lipid-lowering drug use was significantly higher in male than in female patients (all P < 0.01). Multivariate logistic regression analysis showed that female gender was a predictor for less PCI therapy (P < 0.01). Thirty-day all cause mortality (OR = 1.425, 95%CI: 1.163 - 1.747, P < 0.01) and combined end points (OR = 1.193, 95%CI: 1.010 - 1.410, P = 0.04) were significantly higher in female patients than in male patients.
Conclusions:
There are gender-related differences on therapeutic approach and short-term outcome in Chinese STEMI patients. The unfavorable demographic and baseline clinical profile could partially explain the less reperfusion therapy rate and worse prognosis in female patients.
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