Impact of gender on management and prognosis in patients undergoing emergent coronary angiography for STEMI

Background/Introduction Gender-related differences in the management and outcomes of ST-segment elevation myocardial infarction (STEMI) have been widely reported. Previous studies suggest women may receive less aggressive therapy and have worse outcomes than men. However, contemporary real-world data on pharmacological treatment at discharge and medium-term prognosis following emergent coronary angiography are limited. Purpose To evaluate sex differences in clinical characteristics, discharge pharmacotherapy, and 1-year mortality among patients undergoing emergent coronary angiography for suspected STEMI in a single-center cohort. Methods We conducted a retrospective analysis of 406 consecutive patients (297 men, 109 women) who underwent emergent coronary angiography at our center. Demographics, cardiovascular risk factors, comorbidities, angiographic findings, discharge medications, and clinical outcomes up to 1 year were recorded. C Results Women were older than men (median 68 [IQR 58–79] vs 62 [56–71.25] years; p < 0.001). Left ventricular ejection fraction at discharge was similar between sexes (median 50 [IQR 41.5–58] vs 50 [41.75–55] %; p = 0.253). The type of revascularization (complete, staged, or partial) was similar between men and women (p = 0.703). Complete revascularization was performed in 62.3% of men and 66.1% of women; staged in 14.8% and 12.8%; and partial in 18.2% and 14.7%, respectively. No significant sex-related differences were observed in the prescription of ACE inhibitors/ARBs, MRA, beta-blockers, statins, ezetimibe, P2Y12 inhibitors, SGLT2 inhibitors at discharge. In the unadjusted analysis, women were less likely to be referred to cardiac rehabilitation (40.6% vs. 58.8%, p = 0.002). After adjustment for age, sex was no longer independently associated with referral ( p = 0.72), suggesting that the difference was influenced by age. One-year mortality was comparable between women and men (5.5% vs 4.4%; p = 0.211). Conclusion(s) In this contemporary single-center cohort, women undergoing emergent coronary angiography for suspected STEMI exhibited similar type of revascularization, discharge pharmacological therapy, and 1-year mortality compared with men. These findings suggest that, in our center, contemporary management and medium-term outcomes are similar for men and women, supporting equitable care regardless of sex.