Higher mortality in women after ST-segment elevation myocardial infarction in very young patients
Marcin Sadowski1, Agnieszka Janion-Sadowska, Mariusz Gąsior
1Świętokrzyskie Cardiology Centre, Kielce, Poland.
Insights
Young women under 40 experiencing ST-segment elevation myocardial infarction (STEMI) face higher long-term mortality than men. Despite similar risk factors and treatments like primary percutaneous coronary intervention (PCI), women
Area of Science:
- Cardiology
- Acute Coronary Syndromes
- Gender Health Disparities
Background:
- Mortality data for young ST-segment elevation myocardial infarction (STEMI) patients are conflicting.
- Prognosis in women under 40 after STEMI requires further investigation.
Purpose of the Study:
- To investigate the long-term prognosis of women under 40 following STEMI.
- To compare mortality rates between young women and men after STEMI.
Main Methods:
- Analysis of 527 STEMI patients aged 20-40 years from a nationwide registry.
- Comparison of clinical characteristics, risk factors, and treatment strategies between genders.
- Evaluation of in-hospital and 12-month mortality rates.
Main Results:
- No significant gender differences in risk factors, clinical presentation, or reperfusion times.
- High success rate for primary percutaneous coronary intervention (PCI) in both genders.
- Significantly higher 12-month mortality in women (10.8%) compared to men (3.0%).
Conclusions:
- Long-term mortality after STEMI is significantly higher in women under 40 than in men.
- This disparity persists despite similar clinical profiles and management, including primary PCI.
- Further research is needed to understand the underlying reasons for higher female mortality.
Introduction:
Data on mortality in young patients with ST-segment elevation myocardial infarction (STEMI) when compared to older people or regarding therapeutic strategies are contradictory. We investigate the prognosis of women under 40 after STEMI in a prospective nationwide acute coronary syndrome registry.
Material And Methods:
We analyzed all 527 consecutive men and women (12.3% females) aged from 20 to 40 years (mean 35.7 ±4.5) presenting with STEMI, of all 26035 STEMI patients enrolled.
Results:
Differences between genders in the major cardiovascular risk factors, clinical presentation, extent of the disease and time to reperfusion were insignificant. The majority of patients (67%) underwent coronary angiography followed by primary percutaneous coronary intervention (PCI) in 79.9% of them. A 92% reperfusion success rate measured by post-procedural TIMI 3 flow was achieved. There were no significant differences between genders in the administration of modern pharmacotherapy both on admission and after discharge from hospital. In-hospital mortality was very low in both genders, but 12-month mortality was significantly higher in women (10.8% vs. 3.0%; p = 0.003). Killip class 3 or 4 on admission (95% CI 19.6-288.4), age per 5-year increase (95% CI 1.01-3.73) and primary PCI (95% CI 0.1-0.93) affected mortality. In patients who underwent reperfusion there was moderately higher mortality in women than in men (7.1% vs. 1.9%; p = 0.046).
Conclusions:
Despite little difference in the basic clinical characteristics and the management including a wide use of primary PCI, long-term mortality in women under forty after STEMI is significantly higher than in men.
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