Worse outcome in women with STEMI: a systematic review of prognostic studies
Manon G van der Meer1, Hendrik M Nathoe, Yolanda van der Graaf
1Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands.
Insights
Women with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) have higher mortality. This increased risk is linked to unfavorable baseline characteristics and longer symptom-to-balloon times in women.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- ST elevation myocardial infarction (STEMI) treatment has advanced with primary percutaneous coronary intervention (pPCI).
- Existing research has not fully clarified survival differences between men and women undergoing pPCI.
- Investigating these disparities requires analysis of baseline and procedural factors.
Purpose of the Study:
- To systematically review evidence on gender-based survival differences in STEMI patients treated with pPCI.
- To determine if baseline or procedural characteristics explain observed mortality disparities.
- To synthesize current data on women's outcomes in STEMI treated with pPCI.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane databases up to May 10, 2013.
- Inclusion criteria required original data on STEMI patients treated with pPCI and a gender analysis with >100 women.
- Data extraction and pooling were performed where feasible.
Main Results:
- 21 studies (2001-2013) included 47,439 men and 16,927 women.
- Women were older, had higher rates of diabetes and hypertension, and lower smoking rates.
- Women experienced longer symptom-to-balloon times; crude mortality was higher, but adjusted analyses suggested parity.
Conclusions:
- Women with STEMI exhibit higher mortality rates compared to men.
- Unfavorable risk profiles and prolonged symptom-to-balloon times in women contribute to this disparity.
- Risk adjustment mitigates the observed gender-based mortality differences in STEMI treated with pPCI.
Background:
Treatment of ST elevation myocardial infarction (STEMI) has improved enormously since the introduction of primary percutaneous coronary intervention (pPCI). It remains unclear whether differences in survival between women and men treated with pPCI exist and whether these potential differences can be explained by gender or by differences in baseline- or procedural characteristics. Therefore we systematically reviewed the available evidence.
Materials And Methods:
On 10 May 2013 PubMed, Embase and Cochrane were searched for studies comprising original data on STEMI patients treated with pPCI. A separate gender analysis including > 100 women was a requirement. Data were extracted and pooled whenever possible.
Results:
21 studies were included from 2001 to 2013 comprising 47.439 men and 16.927 women. Women were older, had more diabetes (women 24%, men 15%) and hypertension (women 58%, men 45%), and were less current smokers (women 30%, men 54%). The procedural characteristics were comparable except for a longer symptom-to-balloon time (women 266 min, men 240 min) and less use of GP IIb/IIIa inhibitors in women (women 51%, men 57%). Crude short- and long-term mortality was higher in women. Although we could not pool adjusted mortality proportions due to heterogeneity, generally the difference in mortality disappeared after adjustment for baseline- and procedural characteristics.
Conclusion:
Mortality is higher in women with STEMI and can be explained by their unfavourable risk profile and longer symptom-to-balloon time.
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