Sex-Based Differences in Revascularization and 30-Day Readmission After ST-Segment-Elevation Myocardial Infarction in
Diala A Steitieh1, Daniel Y Lu1, Ramsey K Kalil2
1Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America.
Insights
Women with ST-segment elevation myocardial infarction (STEMI) receive less revascularization and have higher readmission rates. Revascularization did not reduce readmissions for women, unlike in men.
Area of Science:
- Cardiology
- Cardiovascular Research
- Health Services Research
Background:
- Cardiovascular disease is a leading cause of death for women in the U.S.
- Revascularization is standard for ST-segment elevation myocardial infarction (STEMI) and reduces readmissions.
- Limited data exists on sex-specific impacts of revascularization on readmission rates.
Purpose of the Study:
- To investigate sex differences in revascularization rates for STEMI patients.
- To examine sex disparities in 30-day readmission rates following STEMI.
- To identify primary causes of readmission and assess the impact of revascularization on readmission likelihood in women versus men.
Main Methods:
- Analysis of Nationwide Readmissions Database (2010-2014) for STEMI hospitalizations.
- Comparison of revascularization rates (percutaneous coronary intervention, coronary artery bypass graft surgery) between sexes.
- Assessment of 30-day readmission rates and causes, with multivariable regression to identify predictors.
Main Results:
- Women (219,944) were older and had more comorbidities than men (489,605).
- Women had significantly lower revascularization rates (PCI OR: 0.68; CABG OR: 0.40).
- Women experienced higher 30-day readmission rates (15.7% vs. 10.8%) with heart failure as the primary cardiac cause; revascularization did not decrease their readmission likelihood.
Conclusions:
- Women with STEMI face lower revascularization rates and higher 30-day readmission rates compared to men.
- Revascularization in women post-STEMI was not associated with reduced readmission, unlike in men.
- Further research is needed to understand and address sex-based disparities in STEMI care and outcomes.
Background:
Cardiovascular disease is the leading cause of death for women in the United States. Revascularization is considered the standard of care for treatment of ST-segment elevation myocardial infarction (STEMI) and is known to reduce readmission. However there is a paucity of data that examines the sex-dependent impact of revascularization on readmission. We aimed to investigate sex differences in revascularization rates, 30-day readmission rates, and primary cause of readmissions following STEMIs.
Methods:
STEMI hospitalizations were selected in the Nationwide Readmissions Database from 2010 to 2014. Revascularization rates, 30-day readmission rates, and primary cause of readmission were examined. Interaction between sex and revascularization was assessed. Multivariable regression analysis was performed to identify predictors of 30-day readmission and revascularization for both sexes.
Results:
219,944 women and 489,605 men were admitted with STEMIs. Women were more likely to be older, and have more comorbidities. Women were less likely to undergo revascularization by percutaneous coronary intervention (adjusted odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.66-0.70) or coronary artery bypass graft surgery (adjusted OR 0.40; CI 0.39-0.44). Women had higher 30-day readmission rates (15.7% vs. 10.8%, p < 0.001; OR 1.20, CI 1.17-1.23), and revascularization in women was not associated with a decreased likelihood of 30-day readmission. The primary cardiac cause of readmission in women was heart failure.
Conclusion:
Compared to men, women with STEMIs had lower rates of revascularization and higher rates of 30-day readmission. When revascularized, women were still more likely to be readmitted as compared to non-revascularized women.
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