Sex differences in hospital mortality with the myocardial infarction code

There are differences in acute coronary syndrome (ACS), with a worse prognosis in women.

To evaluate sex differences in presentation, management of the myocardial infarction code and in-hospital mortality in the National Registry of Acute Coronary Syndromes.

A total of 62,118 adults (74% men and 26% women) with ST elevation myocardial infarction (STEMI) or non ST elevation myocardial infarction (NSTEMI) treated in 177 hospitals were included. Treatment and prognosis were compared.

Women had higher comorbidity and lower smoking rates. STEMI was more prevalent in men (73.0% vs. 63.6%), and Non ST Elevation-Acute Coronary Ayndrome (NSTE-ACS) was more prevalent in women (36.4% vs. 27.0%). Under the heart attack code, reperfusion rates were higher in men: percutaneous coronary intervention (PCI) 28.3% vs. 27.9%, fibrinolytic therapy (FT) 36.4% vs. 31.9%, and pharmaco-invasive strategy (PIS) 7.9% vs. 7.2%, respectively; non-reperfusion rates were higher in women (27.3% vs. 33%; p < 0.0001). Complications were more frequent in women, and mortality was also higher in women (15.3% vs. 10.4%; OR: 1.56; 95% CI: 1.48-1.65). In logistic regression, female sex, age, diabetes, and hypertension independently predicted in-hospital death.

Women received less reperfusion, greater comorbidity and mortality, therefore timely and equitable care in the myocardial infarction code must be guaranteed.