Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation
Leonardo De Luca1, Marco Marini2, Lucio Gonzini3
1Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome), Italy.
Insights
Despite advancements in ST-elevation myocardial infarction (STEMI) treatment, women consistently face higher in-hospital mortality rates than men. This disparity persists across all age groups, highlighting a critical area for further research and intervention in STEMI care.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Sex- and age-specific disparities in ST-elevation myocardial infarction (STEMI) treatment and outcomes are well-documented.
- Contemporary trends in STEMI management and outcomes require detailed analysis across diverse demographic groups.
Purpose of the Study:
- To investigate age- and sex-matched trends in the in-hospital management and outcomes of patients diagnosed with STEMI.
- To identify factors contributing to mortality differences between men and women with STEMI across various age strata.
Main Methods:
- Analysis of data from 5 Italian nationwide prospective registries (2001-2014) including 13,235 STEMI patients.
- Age- and sex-matched analyses were performed across four age classes: <55, 55-64, 65-74, and ≥75 years.
- Evaluation of treatment shifts (thrombolysis vs. primary PCI) and in-hospital mortality rates using multivariable logistic regression.
Main Results:
- A significant shift from thrombolysis to primary percutaneous coronary intervention (PCI) was observed over time, improving reperfusion rates across all groups.
- Crude in-hospital mortality rates were higher in women (8.4%) than men (3.2%), increasing with age for both sexes.
- Female sex (OR 1.44) and older age (OR 1.09) were independently associated with higher in-hospital mortality, with no significant interaction between sex and age.
Conclusions:
- Despite widespread adoption of primary PCI for STEMI, women exhibit higher in-hospital mortality compared to men.
- This mortality gap in STEMI patients is evident across all age groups and warrants targeted strategies.
- Further research is needed to understand and address the persistent sex-based disparities in STEMI outcomes.
Background:
Age- and sex-specific differences exist in the treatment and outcome of ST-elevation myocardial infarction (STEMI). We sought to describe age- and sex-matched contemporary trends of in-hospital management and outcome of patients with STEMI.
Methods And Results:
We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age- and sex-matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in-hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07-1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07-1.93, P=0.009) were found to be significantly associated with in-hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61).
Conclusions:
Despite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in-hospital mortality than men, irrespective of age.
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