Gender bias in acute myocardial infarction care in India: Nationwide retrospective study of 41832 patients

BACKGROUND: Various studies have documented gender differences in the management and outcomes of acute myocardial infarction (AMI) in developed countries. Gender differences in the management of AMI in India is not known. OBJECTIVES: To document the gender differences in the management and outcomes of AMI in India. METHODS: The current study was a nationwide retrospective, multicenter, cross-sectional study including all consecutive AMI patients admitted from 15th March to 15th June in the year 2020 using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. RESULTS: There were only 9018 females (21.6 %) among the 41832 patients with AMI in the study. Females were older and were more likely to present with non ST-elevation MI than men (41.6 % vs. 33.2 %). Significantly fewer number of females underwent primary percutaneous coronary intervention (29.5 % vs 31.2 % p value < 0.001), thrombolysis (32.9 % vs 34.7 %, p value < 0.001), pharmaco-invasive therapy (18.6 % vs 20.7 % p value 0.001). Females had higher in-hospital mortality (7.07%vs 4.07 %, p < 0.001), length of hospital stay (3.9 ± 2.98 days vs 3.8 ± 2.88 days, p < 0.001) and complications of AMI [cardiogenic shock (8.6 % vs 6.3 %), mechanical complications (4.6 % vs 3.8 %), heart failure (13.9%vs 11.7 %) and malignant arrhythmias (3.4%vs2.8 %)] than males. CONCLUSIONS: Differences between gender in the presentation, management, and outcomes of acute MI are prevalent in India. Women with acute MI presented at older age, had higher in-hospital mortality and complications, and received revascularization therapy less often compared to men.