Persistent sex disparities in presentation, invasive management, and in-hospital mortality in patients with acute myocardial infarction: an 11-year national cohort study

Background and Aim Sex-related disparities in the presentation, management, and outcome of acute myocardial infarction (AMI) persist globally. However, evidence from transitional healthcare systems remains limited. We aimed to investigate sex-based differences in clinical characteristics, invasive management, and in-hospital outcomes among patients hospitalized with AMI in Kosovo over an 11-year period. Methods In this observational cohort study, 13,099 consecutive patients admitted with AMI between 2014 and 2024 were analyzed. Demographic, clinical, and procedural data were compared by sex. Trends were evaluated using polynomial regression, and predictors of in-hospital mortality were assessed using multivariable logistic regression. Results Women comprised 29% of the cohort (n = 3,759) and were older than men (67.7 ± 11.0 vs. 62.2 ± 11.3 years; p < 0.001). Hypertension and diabetes were more prevalent in women (78 vs. 62% and 48 vs.31%, respectively; p < 0.001 for both), while smoking was more prevalent in men (58 vs. 26%; p < 0.001). Women underwent coronary angiography and primary PCI less often (64 vs. 73% and 47 vs. 55%; p < 0.001 for both) and had higher in-hospital mortality (14 vs. 6.2%; p < 0.001). After adjustment, increasing age and diabetes mellitus independently predicted mortality in both sexes. Conclusions In this national cohort from a transitional health care system, women with AMI presented at older age, carried greater comorbidity burden, received less invasive management, and experienced higher in-hospital mortality. These findings highlight the need for targeted strategies to ensure equitable access to reperfusion therapy and sex-specific cardiovascular prevention.