Sex-Based Differences in Discharge Disposition and Outcomes for ST-Segment Elevation Myocardial Infarction Patients Within a Regional Network

BACKGROUND: It is known that women with ST-segment elevation myocardial infarction (STEMI) have higher mortality in comparison to men. While the reasons for this sex-based difference are not completely understood, biologic differences and disparities in care have been implicated. Whether these differences persist within an urban, regional STEMI system of care with defined protocols is unclear. Our objective was to explore sex-related effects in outcomes in a large regional system of care. MATERIALS AND METHODS: Data were drawn from a regional subset of the National Cardiovascular Data Registry for 33 hospitals in and around Dallas County, Texas from 2010 to 2015. We explored adjusted differences between women and men for discharge disposition, door to balloon (D2B), total ischemic time (TIS), length of stay, and in-hospital mortality rates. RESULTS: Multivariate regressions to control for confounding factors, including age, D2B, and TIS, were significantly prolonged in women compared to men (D2B 58 vs. 54 minutes; TIS 206 vs. 178 minutes; both p < 0.001). Length of stay was 0.45 median days longer. Women were also much less likely to survive at discharge than men odds ratio (OR): 0.63; 95% confidence interval (CI): 0.52-0.76. Most notably, they were much less likely to be discharged to home than men (88% vs. 92%, p < 0.001). CONCLUSIONS: In this study, we found that sex-based disparities persist for both cardiovascular outcomes and discharge disposition, even in a modern regionalized system of care.