Trends in sex differences in clinical characteristics, treatment strategies, and mortality in patients with ST-elevation myocardial infarction in Poland from 2005 to 2011

INTRODUCTION: During the last decade, there has been an increased awareness of sex differences in the clinical characteristics, management, and mortality in myocardial infarction. Many previous studies have found that women with ST-elevation myocardial infarction (STEMI) have a poorer baseline risk profile, are less intensively treated, and have worse outcomes. OBJECTIVE: To evaluate whether sex disparities in STEMI have changed in recent years. METHODS: This is a retrospective analysis of data on 111 148 STEMI patients enrolled in the Polish Registry of Acute Coronary Syndromes between 2005 and 2011. Temporal trends in the clinical presentation, treatment strategies, and mortality rates between men and women are compared. RESULTS: Throughout the study, women were, on average, older than men, and more frequently presented with hypertension, diabetes, or obesity. These differences showed a tendency for narrowing. The percentage of smokers increased in both sexes. Despite a reduction in prehospital delays, they remained longer in women. Sex differences in prehospital cardiac arrest and cardiogenic shock at admission disappeared. In 2011, women were still less likely to undergo coronary angiography with subsequent revascularization, but it was mainly driven by patients older than 70 years of age who also had a higher in-hospital mortality. Despite the greater relative risk reductions, the crude mortality rates remained significantly higher in women. Female sex was not an independent predictor of mortality. CONCLUSION: Sex differences in STEMI patients were narrowing from 2005 to 2011 in Poland. However, more attention needs to be focused on increasing smoking prevalence, the longer times from symptoms onset to hospital admission in women and the lower frequencies of the use of an invasive treatment strategy in older women, and their worse in-hospital outcomes.