Key result
Younger women with STEMI face ~67% worse prognosis and receive less evidence-based treatment than men.
Why the study?
Does female gender affect prognosis, clinical course, and management after acute myocardial infarction compared to male gender?
Does female gender affect prognosis, clinical course, and management after acute myocardial infarction compared to male gender?
Younger women and women with STEMI have a disproportionately poor prognosis and are less likely to receive evidence-based therapies compared to men, highlighting a persistent gender gap in acute MI care.
Background Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender‐specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist. Methods and Results We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web‐System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age‐adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST‐segment elevation MI. Compared with men, younger women and women with ST‐segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16, P <0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48, P <0.001) and were less likely to be prescribed evidence‐based treatment at discharge ( P <0.001 for β‐blockers, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y 12 antagonists). Differences in treatment between the genders did not decrease over the study period ( P >0.1 for all treatments). Conclusions Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST‐segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence‐based treatment.
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Redfors et al. (2015) studied this question. Younger women and women with ST-segment elevation MI experienced worse prognosis and were less likely to receive evidence-based treatments compared to men (OR 1.67, 1.31).
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