Sex-Related Differences in Outcomes for Patients With ST Elevation Myocardial Infarction (STEMI): A Tamil Nadu-STEMI
Thomas Alexander1, Suma M Victor2, Balakumaran Jayakumaran1
1Kovai Medical Centre Hospital, Coimbatore, Tamil Nadu, India.
Insights
Women with ST elevation myocardial infarction (STEMI) present later and have worse outcomes than men. This study highlights the increased mortality risk for females experiencing STEMI, emphasizing a critical need for targeted care.
Area of Science:
- Cardiology
- Public Health
- Sex Differences in Medicine
Background:
- ST elevation myocardial infarction (STEMI) is a significant cause of coronary artery disease presentation in India.
- Women with STEMI often face higher risks of adverse outcomes compared to men due to various contributing factors.
- Understanding sex-based disparities in STEMI is crucial for improving patient care and outcomes.
Purpose of the Study:
- To investigate and compare the clinical characteristics and prognosis of male and female patients diagnosed with STEMI.
- To identify sex-related differences in STEMI presentation, management, and outcomes within a healthcare system.
- To evaluate the impact of sex on short-term and long-term mortality in STEMI patients.
Main Methods:
- Subgroup analysis of the prospective, observational Tamil Nadu-STEMI (TN-STEMI) program.
- Inclusion of 2,420 patients with STEMI from four hub-and-spoke clusters in Tamil Nadu, India, between 2012 and 2014.
- Data combined from pre- and post-integrated STEMI system implementation, with a 1-year follow-up period.
Main Results:
- Female patients presented later (mean age 60.1 years vs. 53.7 years) and had higher prevalence of diabetes and hypertension.
- Symptom onset to first medical contact was delayed in women (193 mins vs. 170 mins).
- Women experienced significantly higher in-hospital (10.4% vs. 4.8%) and 1-year mortality (26.7% vs. 13%), persisting even in younger populations (<45 years).
Conclusions:
- Women with STEMI exhibit an unfavorable risk profile compared to men.
- Adverse short-term and long-term prognoses are observed in female STEMI patients.
- Adjusted regression analysis indicated an increased likelihood of mortality in females (1.8 times).
Background:
ST elevation myocardial infarction (STEMI) represents a large proportion of the clinical presentation of coronary artery disease in Indian people. Owing to multiple factors contributing to the sex difference, women with STEMI are thought to have a higher risk of adverse outcomes than men. The aim of this study was to evaluate sex-related differences in the clinical characteristics and prognosis of patients with STEMI within a system of care.
Method:
This study was a subgroup analysis of the Tamil Nadu-STEMI (TN-STEMI) program, a multicentre, prospective, observational study of a quality-improvement program studying patients with STEMI at four hub-and-spoke clusters in the southern state of Tamil Nadu, India. In total, 2,420 patients were enrolled between 2012 and 2014, and the data from all four clusters, pre- and postimplementation of integrated STEMI systems, were combined for this analysis, with a 1-year follow-up.
Results:
The mean ± SD age of presentation of female patients (16%) was significantly later (60.1±10.9 years) compared with males (84%; 53.7±12 years). Diabetes was more prevalent in women (35.2% vs 23.8%; p<0.001), as was hypertension (35.2% vs 22.9%; p<0.001). Symptom to first medical contact in female patients was significantly delayed compared with males (193 mins vs 170 mins; p≤0.009). Women had higher mortality, both in hospital (10.4% vs 4.8%; p≤0.001) and at 1 year (26.7% vs 13%; p≤0.001). This pattern was persistent, even in the younger STEMI (<45 years) population (in-hospital: 9.1% vs 3% [p≤0.05]; at 1 year: 18.2% vs 3% [p≤ 0.05]). In the regression model, females had a 1.8 times increased likelihood (p<0.04) of mortality after adjusting for confounders.
Conclusions:
Among patients with STEMI, women have an unfavourable risk profile and adverse short- and long-term prognoses when compared to men.
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