Female sex was associated with a higher adjusted risk of in-patient mortality following STEMI compared to men (OR 2.33; 95% CI 1.11-4.86), which attenuated after adjusting for treatment factors.
Observational (n=1,194)
No
Does female sex impact management pathways and clinical outcomes in STEMI patients compared to male sex?
Women presenting with STEMI experience significant delays in diagnosis and receive less guideline-directed care compared to men, leading to worse unadjusted early outcomes that are largely explained by these treatment disparities.
Odds Ratio: 2.33 (95% CI 1.11–4.86)
Abstract Introduction Primary percutaneous coronary intervention (pPCI) has significantly improved outcomes in ST-segment elevation myocardial infarction (STEMI). However, women continue to experience poorer outcomes compared with men. Purpose Despite international evidence of sex disparities in STEMI care, contemporary Irish data remain limited. This study evaluated sex differences in the management and outcomes of STEMI in a tertiary centre in Ireland. Methods A retrospective analysis was performed on an anonymised dataset of 1,194 consecutive STEMI patients (24.2% female) presenting between January 2022 and December 2024 to a large tertiary centre. Management pathways, procedural characteristics, complications, and mortality were assessed. Results Women were older (66.8±12.8 vs 62.1±12.1 years, p0.001) and had higher rates of hypertension (51.6% vs 43.8%, p=0.024) and diabetes (35.3% vs 28.6%, p=0.041), but lower rates of previous MI (7.4% vs 12.2%, p=0.023). Women had longer symptom-to-balloon times (272.5 vs 224 minutes, p=0.003), were less often transferred directly to the catheterisation laboratory (65.3% vs 73.9%, p=0.041) and more frequently experienced diagnostic delay (23.9% vs 13.5%, p=0.046). They were less likely to receive second antiplatelet therapy on admission (97.6% vs 99.4%, p=0.011). Despite similar reperfusion rates (90.1% vs 91.4%, p=0.734), women had higher rates of incomplete PCI (3.6% vs 1.6%, p=0.044), were less likely to undergo non-culprit vessel intervention (16% vs 22.7%, p=0.015), and less frequently underwent radial access (90.6% vs 94.8%, p=0.010). On discharge, women were less likely to receive aspirin (96.2% vs 98.3%, p=0.038), statins (97.5% vs 99.5%, p=0.017), ACE-inhibitors (86.6% vs 92%, p=0.018), and referral to cardiac rehabilitation (72.6% vs 79.3%, p=0.013). After adjustment for age and cardiovascular risk factors, women had higher risks of in-patient mortality (OR 2.33, 95% CI 1.11-4.86), bleeding (OR 2.30, 95% CI 1.13-4.67), and congestive cardiac failure (OR 1.57, 95% CI 1.07-2.31). These associations were no longer statistically significant after sequential adjustment for treatment-related variables, including symptom-to-reperfusion time and vascular access route. Conclusion Significant sex differences in STEMI care were evident across diagnostic delays, procedural strategies, and prescription of secondary prevention therapies. These disparities were associated with worse unadjusted early outcomes in women but were attenuated after accounting for treatment-related factors. Targeted strategies to improve timely diagnosis and delivery of guideline-directed care for women may help reduce these gaps.Baseline DemographicsFor image description, please refer to the figure legend and surrounding text. Multivariate AnalysisFor image description, please refer to the figure legend and surrounding text.
Hale et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=1,194). Female sex vs. Male sex was evaluated on in-patient mortality (OR 2.33, 95% CI 1.11-4.86). Female sex was associated with a higher adjusted risk of in-patient mortality following STEMI compared to men (OR 2.33; 95% CI 1.11-4.86), which attenuated after adjusting for treatment factors.