ST-Segment Elevation Myocardial Infarction Differences between Genders - A Single Center Retrospective Analysis
Cátia Costa Oliveira1,2, Filipe Vilela2, Carlos Braga1
1Serviço de Cardiologia, Hospital de Braga, Braga - Portugal.
Insights
Women with ST-elevation myocardial infarction (STEMI) experience higher mortality rates after primary percutaneous coronary intervention (PCI). Despite worse risk profiles and longer reperfusion times, female gender was not an independent predictor of mortality in this study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Gender Disparities in Healthcare
Background:
- Outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) have improved.
- However, women consistently demonstrate higher mortality rates compared to men following primary PCI for STEMI.
Purpose of the Study:
- To investigate gender-based differences in the clinical presentation, management strategies, and in-hospital and long-term mortality following STEMI.
- To identify factors contributing to potential disparities in care and outcomes between men and women.
Main Methods:
- A retrospective analysis of 809 consecutive patients treated with primary PCI for STEMI was conducted.
- Data on patient demographics, comorbidities, clinical presentation, treatment, and outcomes were collected and compared between female and male patients.
Main Results:
- Women were older and had a higher prevalence of comorbidities including diabetes, hypertension, and chronic kidney disease.
- Women presented with more atypical symptoms, experienced longer times to reperfusion, and were less likely to receive optimal medical therapy.
- In-hospital, 30-day, 6-month, and 1-year mortality rates were significantly higher in women compared to men.
Conclusions:
- Women with STEMI undergoing primary PCI exhibit a worse risk profile and experience higher mortality rates.
- Systemic delays contributing to longer reperfusion times and suboptimal medical therapy in women may influence outcomes.
- Despite higher mortality, female gender was not identified as an independent prognostic factor for mortality in the multivariate analysis.
Background:
Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI) have improved, women show higher mortality.
Objectives:
To assess gender differences in presentation, management and in-hospital mortality, at 30-days, 6-months and 1-year after STEMI.
Methods:
We retrospectively collected data from 809 consecutive patients treated with primary PCI and compared the females versus males at the local intervention cardiology database. The level of significance used was p<0.05.
Results:
Women were older than man (69,1±14,6 vs. 58,5±12,7 years; p<.001) with higher prevalence of age over 75 years (36.7% vs. 11.7%; p<.001), diabetes (30,6% vs. 18,5%; p=.001), hypertension (60.5% vs. 45.9%; p=.001), chronic kidney disease (3.4% vs. 0.6%; p=.010) and acute ischemic stroke (6.8% vs. 3.0%; p=.021). At presentation, women had more atypical symptoms, less chest pain (p=.014) and were more frequently in cardiogenic shock (p=.011)). Women had longer time until reperfusion (p=.001) and were less likely to receive optimal medical therapy (p<0.05). In-hospital mortality (p=.001), at 30-days (p<.001), 6-months (p<.001) and 1-year (16.4% vs. p<.001) was higher in women. The multivariate analysis identified age over 75 years (HR=4.25; 95% CI[1.67-10.77];p=.002), Killip class II (HR=8.80; 95% CI[2.72-28.41];p<.001), III (HR=5.88; 95% CI [0.99-34.80]; p=.051) and IV (HR=9.60; 95% CI[1.86-48.59];p=.007), Acute Kidney Injury (HR=2.47; 95% CI[1.00-6.13];p=.051) and days of hospitalization (HR=1.04; 95% CI[1.01-1.08];p=.030) but not female gender (HR=0.83; 95% CI[0.33-2.10];p=.690) as independent prognostic factors of mortality.
Conclusions:
Compared to men, women with STEMI undergoing primary PCI have higher mortality rates. Women admitted for STEMI have a worse risk profile, are treated with a higher reperfusion time related with system delays and are less likely to receive the recommended therapy. Female gender was not an independent prognostic factor for mortality in the studied population.
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