Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity
Anoop Mathew1,2, Yongzhe Hong3, Haran Yogasundaram1
1Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada.
Insights
Women with ST-segment myocardial infarction (STEMI) face worse outcomes, including higher mortality, compared to men. Delays in reperfusion therapy contribute significantly to these disparities in STEMI care.
Area of Science:
- Cardiology
- Clinical Research
- Sex-Based Medicine
Background:
- Sex-based differences in ST-segment myocardial infarction (STEMI) outcomes are documented globally.
- Previous studies on sex differences in STEMI within the Indian population have yielded inconsistent findings.
Purpose of the Study:
- To investigate sex-based disparities in 1-year outcomes among patients with STEMI in Kerala, India.
- To identify factors contributing to potential differences in STEMI management and outcomes between men and women.
Main Methods:
- A prospective, multicenter registry of STEMI patients undergoing percutaneous coronary intervention (PCI) in Kerala, India.
- Propensity score matching was employed to compare 1-year outcomes between male and female STEMI patients.
- The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and heart failure rehospitalization.
Main Results:
- Women with STEMI were older, had more cardiovascular risk factors, and higher rates of poverty.
- Post-matching, women experienced significantly higher MACE (20.9% vs. 14.3%) and mortality (14.3% vs. 8.6%) at 1 year.
- Women faced greater prehospital delays and delayed primary PCI compared to men, despite similar reperfusion rates.
Conclusions:
- Women in this Indian cohort exhibit poorer 1-year outcomes following STEMI, primarily due to increased mortality.
- Timeliness of reperfusion therapy is a critical factor influencing outcome disparities between sexes.
- Targeting quality improvement initiatives to reduce reperfusion delays may mitigate sex-based outcome differences in STEMI.
Background:
Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results.
Methods:
A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)-capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score-matched groups were compared.
Results:
We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, P < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, P < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, P = 0.03). Procedural characteristics were similar between groups.
Conclusions:
Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
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