Impact of comorbid mental disorders on in‑hospital mortality and complications after ST‑segment elevation myocardial infarction

Background Psychiatric comorbidities are common among patients with ST-segment elevation myocardial infarction (STEMI) and may be associated with in-hospital outcomes, which may differ among sexes.Methods Using the National Inpatient Sample, an administrative claims database, we identified adults hospitalized with STEMI and psychiatric comorbidities and performed a retrospective cross-sectional observational study. Multivariable logistic regression and propensity-score matching were applied; outcomes were assessed between females and males with subgroup analyses for individual psychiatric conditions.Results Of 145,830 patients, 45.51% were female. Female sex was associated with higher odds of in-hospital mortality (aOR 1.13, 95% CI: 1.01–1.26, p = 0.031) and pulmonary embolism (aOR 1.54, CI: 1.05–2.26, p = 0.027), and lower odds of cardiogenic shock (aOR 0.85, 95% CI: 0.79–0.92, p < 0.001). Female sex was also associated with lower odds of acute heart failure, acute kidney injury, cardiac arrhythmias, and device use (p < 0.05). Directional associations persisted after propensity-matching. Subgroup analyses corroborated trends and revealed female post-traumatic stress disorder patients demonstrated higher odds of in-hospital mortality (aOR 2.40, 95% CI 1.37–4.22, p = 0.002).Conclusion Among patients with STEMI and psychiatric disorders, female sex was associated with higher odds of in-hospital mortality and lower odds of several adverse complications. Psychiatric comorbidities are heterogeneous, however, and findings vary.