Evaluation of clinical features and metrics of care in women with st-elevation myocardial infarction treated in a pharmaco-invasive strategy network

Introduction Despite worse cardiovascular outcomes, including higher mortality, reported in women with acute myocardial infarction, it is uncertain whether these differences can be explained by a discordant risk profile between genders. Objective To compare clinical data and metrics of care between women and men diagnosed with ST elevation myocardial infarction (STEMI). Methods We analyzed 2723 consecutive STEMI patients, of whom 29.8% (811) were women, treated in a regional network from March-2010 to December-2019, first seen in primary hospitals, where they received fibrinolysis (96% tenecteplase), and then systematically transferred to a tertiary center for cardiac catheterization (pharmaco-invasive strategy). Categorical variables were compared using chi-square test and numerical variables expressed as median and interquartile range and compared using Mann-Whitney test. A binary logistic regression model was developed to determine whether female gender was an independent predictor of mortality. Results Compared to men, women were older (60 [53–69] x 56 [49–63] years; p<0.01), had more hypertension (68.9% x 56.5%; p<0.01), diabetes (36.6% x 28.3%; p<0.01), hypothyroidism (12.0% x 3.3%; p<0.01), kidney failure with an estimated creatinine clearance <60 mL/min (24.7% x 15.4%; p<0.01) and higher baseline LDL-cholesterol (128 [107–160] x 124 [100–154] mg / dL; p=0.03). Smoking (65.2% x 58.2%; p<0.01) and alcoholism (16.1% x 3.1%; p<0.01) were more frequent in men. Regarding the metrics of care, women had longer times from symptoms onset to first medical contact (120 [60–240] x 115 [60–210] minutes; p=0.02) and longer pain-to-needle median times (69 [42–120] x 72 [49–120] minutes; p=0.03). There was no difference between genders regarding percentage of failure reperfusion after lytic, median time from fibrinolysis to cardiac catheterization, maximum troponin values and days of hospitalization. Women had higher unadjusted in-hospital mortality (8.0% x 4.8%; p<0.01). However, after adjusting for confounding variables in the multivariate regression model, the female gender was not an independent predictor of death (odds ratio 1.17 with a 95% confidence interval of 0.69–1.80). Conclusion After adjusting for risk variables, female gender was not related to higher in-hospital mortality in STEMI patients treated with pharmaco-invasive strategy. However, women had a higher cardiovascular risk profile compared to men and worse metrics of care, including greater delay in reperfusion therapy. Funding Acknowledgement Type of funding source: None