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Differences in management and outcomes for men and women with ST-elevation myocardial infarction
Ehsan Khan1, David Brieger2, John Amerena3
1Flinders Medical Centre, Adelaide, SA ekha3150@uni.sydney.edu.au.
Insights
Women with ST-elevation myocardial infarction (STEMI) receive less invasive management and revascularization. They also experience higher adverse event rates and receive fewer preventive treatments post-discharge, indicating disparities in care.
Area of Science:
- Cardiology
- Clinical Research
- Sex Differences in Medicine
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Understanding sex-based differences in STEMI management and outcomes is crucial for equitable healthcare.
- Previous studies suggest potential disparities in treatment and outcomes between men and women with STEMI.
Purpose of the Study:
- To investigate sex-based differences in the characteristics, management strategies, and clinical outcomes of patients diagnosed with STEMI.
- To identify potential disparities in the application of revascularization procedures and preventive therapies for male and female STEMI patients.
- To analyze the impact of these differences on major adverse cardiac events and mortality.
Main Methods:
- A prospective cohort study analyzing data from the CONCORDANCE acute coronary syndrome registry.
- Inclusion of 2898 patients (2183 men, 715 women) with STEMI from 41 Australian hospitals (February 2009 - May 2016).
- Comparison of revascularization rates (PCI, thrombolysis, CABG), timely vascularization, major adverse cardiac events, and discharge medications between sexes, adjusted for the GRACE risk score.
Main Results:
- Women with STEMI were older and presented with more comorbidities (hypertension, diabetes, chronic kidney disease) than men.
- Women were less likely to undergo coronary angiography, revascularization, timely revascularization, or primary PCI compared to men.
- Six-month follow-up revealed higher rates of major adverse cardiovascular events and mortality in women, who also received fewer beta-blockers, statins, and cardiac rehabilitation referrals at discharge.
Conclusions:
- Women experiencing STEMI are undertreated with invasive procedures and revascularization.
- Significant disparities exist in the receipt of preventive medications and cardiac rehabilitation referrals at discharge for women post-STEMI.
- The underlying reasons for these persistent differences in care require urgent investigation to improve outcomes for female STEMI patients.
Objective:
To examine whether there are sex differences in the characteristics, management, and clinical outcomes of patients with an ST-elevation myocardial infarction (STEMI). Design, setting: Cohort study; analysis of data collected prospectively by the CONCORDANCE acute coronary syndrome registry from 41 Australian hospitals between February 2009 and May 2016.
Participants:
2898 patients (2183 men, 715 women) with STEMI.
Main Outcome Measures:
Rates of revascularisation (percutaneous coronary intervention [PCI], thrombolysis, coronary artery bypass grafting [CABG]), adjusted for GRACE risk score quartile.
Secondary Outcomes:
timely vascularisation rates; major adverse cardiac event rates; clinical outcomes and preventive treatments at discharge.
Results:
The mean age of women with STEMI at presentation was 66.6 years (SD, 14.5 years), of men, 60.5 years (SD, 12.5 years). The proportions of women with hypertension, diabetes, prior stroke, chronic kidney disease, chronic heart failure, or dementia were larger than those of men; fewer women had histories of previous coronary artery disease or myocardial infarction, or of prior PCI or CABG. Women were less likely to have undergone coronary angiography (odds ratio, adjusted for GRACE score quartile [aOR], 0.53; 95% CI, 0.41-0.69) or revascularisation (aOR, 0.42; 95% CI, 0.34-0.52); they were less likely to have received timely revascularisation (aOR, 0.72; 95% CI, 0.63-0.83) or primary PCI (aOR, 0.76; 95% CI, 0.61-0.95). Six months after admission, the rates of major adverse cardiovascular events (aOR, 2.68; 95% CI, 1.76-4.09) and mortality (aOR, 2.17; 95% CI, 1.24-3.80) were higher for women. At discharge, significantly fewer women than men received β-blockers, statins, and referrals to cardiac rehabilitation.
Conclusion:
Women with STEMI are less likely to receive invasive management, revascularisation, or preventive medication at discharge. The reasons for these persistent differences in care require investigation.
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