Key result
Women with STEMI experience ~43% higher hospital mortality than men alongside worse access to reperfusion.
Why the study?
The effect of gender on access to reperfusion therapy and hospital mortality in STEMI patients is contradictory and requires clarification.
Does female gender impact access to reperfusion therapy and hospital mortality in patients with STEMI?
Cohort (n=4,816)
Yes
Does female gender impact access to reperfusion therapy and hospital mortality in patients with STEMI?
Odds Ratio: 1.43 (95% CI 1–2.06)
p-value: p=0.0492
Women presenting with STEMI experience longer delays, receive less reperfusion therapy, and have significantly higher adjusted hospital mortality compared to men.
Adjusted mortality higher in women with STEMI; leaves open whether unmeasured factors explain the observational disparity.
BACKGROUND: The available evidence about the effect of gender and/or sex on mortality differences is contradictory. Our aim is to assess the impact of gender on the access to reperfusion therapy in patients with acute coronary syndrome with ST-segment elevation (STEMI), and secondly, to analyze the effect of delay on the differences with regard to hospital mortality. METHODS: A retrospective cohort study was conducted among consecutive patients with STEMI included in the ARIAM-SEMICYUC registry (2010-2013). RESULTS: A total of 4816 patients were included (22.09% women). Women were older, presented with longer patient delay (90 vs. 75 minutes, p=0.0066), higher risk profile (GRACE>140: 75.1% vs. 56.05%, p<0.0001), and received less reperfusion therapy (68.8% vs. 74.7%, p<0.0001) with longer total reperfusion time (307 vs. 240 minutes, p<0.0001). Women received less thrombolysis (24.53% vs. 29.98%, p<0.0001) and longer door-to-needle time (85 vs. 70 minutes, p 0.0023). We found no differences regarding primary percutaneous coronary intervention or door-to-balloon time. Women also had higher hospital mortality (crude odds ratio 2.54, 95% confidence interval 1.99-3.26, p<0.0001), which persisted after controlling the effect of patient delay, age, risk (GRACE), and reperfusion (adjusted odds ratio 1.43, 95% confidence interval 1.0-2.06, p=0.0492). Using TIMI or Killip risk scores as risk estimates yielded nonsignificant results. CONCLUSIONS: Compared with men, women with STEMI have worse access to reperfusion and higher hospital mortality. The impact of the differences in accessibility on mortality gap remains uncertain.
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Miguel et al. (2015) conducted a cohort in Acute coronary syndrome with ST-segment elevation (STEMI) (n=4,816). Female gender vs. Male gender was evaluated on Hospital mortality (adjusted OR 1.43, 95% CI 1.0-2.06, p=0.0492). Women with STEMI experienced higher hospital mortality than men (adjusted OR 1.43; 95% CI 1.0-2.06; p=0.0492), alongside worse access to reperfusion therapy.
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