Female sex was associated with decreased overall survival after STEMI compared to men (HR 1.02; 95% CI 1.00-1.04; p=0.036), alongside lower rates of revascularization and guideline-directed therapy.
Cohort (n=175,187)
Yes
Does female sex affect treatment strategies and overall survival in patients with STEMI?
In a contemporary nationwide cohort, women with STEMI received guideline-recommended therapies less frequently than men and had worse overall survival and higher complication rates.
Hazard Ratio: 1.02 (95% CI 1–1.04)
p-value: p=0.036
Background and aims Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. Methods From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. Results Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p < 0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs. 6.6%), longer hospitalizations (12.2 vs. 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%). After adjustment for patient's risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00–1.04; p= 0.036). Notably, more men received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p < 0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50–0.55; men HR 0.48, 95% CI 0.47–0.50, p int = 0.014). Conclusions In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival.
Kuehnemund et al. (Thu,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=175,187). Female sex vs. Male sex was evaluated on overall survival (HR 1.02, 95% CI 1.00-1.04, p=0.036). Female sex was associated with decreased overall survival after STEMI compared to men (HR 1.02; 95% CI 1.00-1.04; p=0.036), alongside lower rates of revascularization and guideline-directed therapy.