Closing the sex gap in time delays and mortality in ST-segment elevation myocardial infarction: insights from the
Gemina Doolub1, Mamas A Mamas1, Krzysztof P Malinowski2,3
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
Insights
Women with ST-elevation myocardial infarction (STEMI) face longer treatment delays and worse outcomes, but the gap is narrowing. This highlights the need for gender-specific approaches in STEMI care to improve outcomes for all patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Sex disparities in cardiovascular care persist, particularly for ST-elevation myocardial infarction (STEMI) patients.
- Despite advancements, differences in treatment and outcomes between men and women with STEMI remain a concern.
Purpose of the Study:
- To analyze temporal trends in sex-based differences in STEMI treatment delays.
- To investigate changes in procedural complications and outcomes for male and female STEMI patients over time.
- To assess the impact of these disparities on patient management and outcomes.
Main Methods:
- Retrospective analysis of 123,829 STEMI patients from the ORPKI Registry (2014-2022).
- Focus on patients without cardiogenic shock undergoing primary percutaneous coronary intervention (PCI).
- Comparison of treatment delays, stent utilization, procedural complications, and in-hospital mortality between sexes.
Main Results:
- Women (32% of cohort) experienced longer delays from symptom onset to first medical contact and PCI.
- Women received stents less frequently (86.8% vs. 89%) and had higher rates of periprocedural complications.
- While disparities exist, a reduction in the mortality gap and absolute decrease in in-cathlab deaths for women were observed over the study period.
Conclusions:
- Significant sex-based disparities in STEMI care persist, with women facing longer delays and poorer immediate outcomes.
- Less aggressive revascularization in women contributes to worse periprocedural results.
- The gradual closing of the outcome gap suggests potential improvements, emphasizing the need for gender-specific STEMI management strategies.
Introduction:
Despite improvements in cardiovascular care, sex disparities persist in the outcomes of patients presenting with ST‑segment elevation myocardial infarction (STEMI).
Objectives:
This study aimed to investigate the change in sex‑based differences in treatment delays, procedural complications, and outcomes among patients admitted for STEMI over the years.
Patients And Methods:
Data from the National Registry of Invasive Cardiology Procedures recorded between 2014 and 2022 were retrospectively analyzed, focusing on patients without cardiogenic shock who underwent primary percutaneous coronary intervention (PCI).
Results:
Women comprised 32% of a total of 123 829 STEMI patients. Treatment delays from chest pain onset to the first medical contact and PCI were longer in women (239 vs 216 min; P <0.001 and 123 vs 114 min; P <0.001, respectively). Women were less likely to be treated with stents (86.8% vs 89%; P <0.001). Periprocedural complications, including cardiac arrest (1.5% vs 1.3%; P = 0.03), perforation (0.3% vs 0.2%; P = 0.03), no‑reflow (1.6% vs 1.3%; P = 0.002), and mortality in a catheterization laboratory (0.8% vs 0.6%; P <0.001), were higher in women. Over time, we have noted a reduction of this mortality gap between men and women since 2014, and an absolute decrease in deaths in the catheterization laboratory for women.
Conclusions:
This study shows significant sex‑based disparities in STEMI care. Women experience longer treatment delays, receive less aggressive revascularization, and have worse periprocedural outcomes than men. However, the gap is gradually closing, which may reflect recent underscoring the need for sex‑specific approaches in STEMI management.
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