Women with STEMI were significantly less likely than men to undergo revascularization (aOR 0.42; 95% CI 0.34-0.52) and had higher 6-month mortality (aOR 2.17; 95% CI 1.24-3.80).
Cohort (n=2,898)
Sí
Are there sex differences in the management and clinical outcomes of patients with STEMI?
Women presenting with STEMI are significantly less likely to receive guideline-directed invasive management and preventive medications, correlating with worse 6-month clinical outcomes compared to men.
Estimación del efecto: aOR 0.42 (95% CI 0.34-0.52)
OBJECTIVE: To examine whether there are sex differences in the characteristics, management, and clinical outcomes of patients with an ST-elevation myocardial infarction (STEMI). Design, setting: Cohort study; analysis of data collected prospectively by the CONCORDANCE acute coronary syndrome registry from 41 Australian hospitals between February 2009 and May 2016. PARTICIPANTS: 2898 patients (2183 men, 715 women) with STEMI. MAIN OUTCOME MEASURES: Rates of revascularisation (percutaneous coronary intervention PCI, thrombolysis, coronary artery bypass grafting CABG), adjusted for GRACE risk score quartile. SECONDARY OUTCOMES: timely vascularisation rates; major adverse cardiac event rates; clinical outcomes and preventive treatments at discharge. RESULTS: The mean age of women with STEMI at presentation was 66.6 years (SD, 14.5 years), of men, 60.5 years (SD, 12.5 years). The proportions of women with hypertension, diabetes, prior stroke, chronic kidney disease, chronic heart failure, or dementia were larger than those of men; fewer women had histories of previous coronary artery disease or myocardial infarction, or of prior PCI or CABG. Women were less likely to have undergone coronary angiography (odds ratio, adjusted for GRACE score quartile aOR, 0.53; 95% CI, 0.41-0.69) or revascularisation (aOR, 0.42; 95% CI, 0.34-0.52); they were less likely to have received timely revascularisation (aOR, 0.72; 95% CI, 0.63-0.83) or primary PCI (aOR, 0.76; 95% CI, 0.61-0.95). Six months after admission, the rates of major adverse cardiovascular events (aOR, 2.68; 95% CI, 1.76-4.09) and mortality (aOR, 2.17; 95% CI, 1.24-3.80) were higher for women. At discharge, significantly fewer women than men received β-blockers, statins, and referrals to cardiac rehabilitation. CONCLUSION: Women with STEMI are less likely to receive invasive management, revascularisation, or preventive medication at discharge. The reasons for these persistent differences in care require investigation.
Khan et al. (Fri,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=2,898). Female sex vs. Male sex was evaluated on Rates of revascularisation (percutaneous coronary intervention [PCI], thrombolysis, coronary artery bypass grafting [CABG]), adjusted for GRACE risk score quartile (aOR 0.42, 95% CI 0.34-0.52). Women with STEMI were significantly less likely than men to undergo revascularization (aOR 0.42; 95% CI 0.34-0.52) and had higher 6-month mortality (aOR 2.17; 95% CI 1.24-3.80).