Sex Differences in 1-Year Rehospitalization for Heart Failure and Myocardial Infarction After Primary Percutaneous...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Sex differences in outcomes after ST-elevation myocardial infarction (STEMI) persist despite advancements in treatment.
• The impact of universal primary percutaneous coronary intervention (pPCI) access on reducing these sex disparities requires further investigation.
• Understanding rehospitalization patterns for heart failure (HF) and myocardial infarction (MI) is crucial for improving post-STEMI care.

Purpose of the Study:

• To evaluate whether universal access to pPCI mitigates sex differences in 1-year rehospitalization for HF and MI post-STEMI.
• To identify specific patient groups or conditions contributing to persistent sex disparities in rehospitalization.

Main Methods:

• A cohort of 7,597 STEMI patients undergoing pPCI between January 2007 and December 2013 was analyzed.
• Cox regression models, adjusted for competing risks of death, assessed sex differences in 1-year rehospitalization for HF and MI.
• Baseline characteristics, comorbidities, treatment variations, and discharge medications were compared between sexes.

Main Results:

• Women were older, had more comorbidities, and experienced longer door-to-balloon times compared to men.
• After adjustment, sex differences in HF rehospitalization risk were attenuated (HR 1.05), but persisted for MI (HR 1.68).
• The disparity in MI rehospitalization was more pronounced in women aged 60 years and older.

Conclusions:

• Universal pPCI access led to similar 1-year HF rehospitalization rates for men and women post-STEMI.
• A significant, adjusted higher risk of 1-year MI rehospitalization persists in women, especially older women.
• Targeted strategies are needed to address sex-specific disparities in MI recurrence and management post-STEMI.