Sex disparities in quality of care and outcomes of patients with cancer presenting with ST elevation myocardial infarction; a nationwide cohort study

Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the patient’s sex plays. Methods A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project (MINAP) and UK national Hospital Episode Statistics Admitted Patient Care (HES APC) registries. The impact of sex on clinical outcomes was assessed using Cox proportional hazard models and competing risk models. Results A total of 8,581 STEMI indexed admissions with cancer who survived to discharge were identified between 1st Jan 2005 and 30th March 2019 (25.8% were women). Women were less likely to be admitted for care under a cardiology consultant (men 72.4%, women 63.9%), receive invasive coronary revascularization (men 60.2%, women 47.2%), or receive dual antiplatelet therapy (men 69.1%, women 61.9%). Women were also less likely to receive optimum care quality (men 64.1%, women 53.1%). After adjusting for confounders, women had higher risk of death within 1-year post-discharge (HR 1.40, 95% CI 1.29-1.53). The risk of major bleeding (HR 0.71, 95% CI 0.51-1.01) and reinfarction (HR 1.00, 95% CI 0.70-1.44) at 1 year were comparable to men. Relative survival analysis showed that 676 (95% CI 192-1,295) female lives across England can be saved at 1 year if sex disparities are addressed. Conclusion In STEMI patients with cancer, women have higher risk of death with hundreds of lives potentially saved if sex disparities in patients’ care are addressed.