Differences in 30-day complications and 1-year mortality by sex in patients with a first STEMI managed by the Codi
Helena Tizón-Marcos1, Beatriz Vaquerizo1, Jaume Marrugat2
1Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
Insights
Women with ST-segment elevation myocardial infarction (STEMI) have similar short-term outcomes as men but experience significantly lower mortality rates one year after a first STEMI event.
Area of Science:
- Cardiology
- Clinical Research
- Sex Differences in Health
Background:
- ST-segment elevation myocardial infarction (STEMI) networks aim to improve reperfusion rates and reduce ischemic times.
- The impact of sex on STEMI prognosis remains a subject of ongoing debate.
- Understanding sex-specific outcomes is crucial for optimizing emergency cardiac care.
Purpose of the Study:
- To investigate the influence of sex on prognosis following a first STEMI.
- To analyze 30-day and 1-year mortality rates in relation to sex.
- To adjust for revascularization delays, age, and comorbidities in the analysis.
Main Methods:
- A multicenter cohort study included 14,690 patients with a first STEMI from 2010 to 2016.
- Prognosis was analyzed by sex, adjusting for key clinical factors.
- End points included 30-day mortality, a composite of 30-day adverse events, and 1-year all-cause mortality.
Main Results:
- Reperfusion times and rates of primary percutaneous coronary intervention (PCI) improved significantly for both sexes during the study period.
- Female sex was not associated with increased 30-day complications after adjustment.
- Women survivors of a first STEMI had a lower adjusted 1-year mortality compared to men.
Conclusions:
- Women experiencing a first STEMI exhibit similar 30-day mortality and complication rates compared to men.
- After accounting for age and severity, women demonstrate significantly lower 1-year mortality post-STEMI.
- These findings highlight potential sex-based differences in long-term recovery from STEMI.
Introduction And Objectives:
ST-segment elevation myocardial infarction (STEMI) emergency care networks aim to increase reperfusion rates and reduce ischemic times. The influence of sex on prognosis is still being debated. Our objective was to analyze prognosis according to sex after a first STEMI.
Methods:
This multicenter cohort study enrolled first STEMI patients from 2010 to 2016 to determine the influence of sex after adjustment for revascularization delays, age, and comorbidities. End points were 30-day mortality, the 30-day composite of mortality, ventricular fibrillation, pulmonary edema, or cardiogenic shock, and 1-year all-cause mortality.
Results:
From 2010 to 2016, 14 690 patients were included; 24% were women. The median [interquartile range] time from electrocardiogram to artery opening decreased throughout the study period in both sexes (119 minutes [85-160] vs 109 minutes [80-153] in 2010, 102 minutes [81-133] vs 96 minutes [74-124] in 2016, both P=.001). The rates of primary PCI within 120 minutes increased in the same period (50.4% vs 57.9% and 67.1% vs 72.1%, respectively; both P=.001). After adjustment for confounders, female sex was not associated with 30-day complications (OR, 1.06; 95%CI, 0.91-1.22). However, female 30-day survivors had a lower adjusted 1-year mortality than their male counterparts (HR,0.76; 95%CI, 0.61-0.95).
Conclusions:
Compared with men, women with a first STEMI had similar 30-day mortality and complication rates but significantly lower 1-year mortality after adjustment for age and severity.
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