Sex differences in STEMI management and outcomes: a retrospective analysis from the China Chest Pain Center Database

Background and purpose: With the development of the China Chest Pain Center (CCPC) and the growing concern over the poor prognosis of female patients with ST-elevation myocardial infarction (STEMI), it is imperative to assess the sex-based differences of in-hospital management, complications, and mortality. This study aims to identify these disparities and make recommendations for the treatment of STEMI patients. Methods: Using the CCPC Database to review the sex disparities in therapeutic procedures and hospitalization death among 462,722 STEMI patients from January 1, 2016, to December 31, 2021. The study outcomes included therapeutic procedures, in-hospital complications, and mortality. Multivariable logistic regression models were used to assess associations between sex and outcomes, adjusting for potential confounders. Results: Of all participants, 112,504 (24.3%) were women. Compared to men, women were older (71.3 vs. 60.5 years), and had a higher prevalence of risk factors and comorbidities. Women also delayed seeking medical assistance, with a longer time from symptom onset to first medical contact (S-to-FMC) compared to men (216 vs. 150 minutes). Women were less likely to receive reperfusion therapy (adjusted odds ratio OR: 0.83, 95% confidence interval 95% CI: 0.81–0.84) and experienced a higher prevalence of in-hospital complications following STEMI. The crude in-hospital mortality rate for women was 6.1%, notably twice as high as that for men (3.0%). Subgroup analyses showed that the sex difference in in-hospital mortality was not significant in younger patients (≤55 years) (adjusted OR: 0.92, 95% CI: 0.71–1.18) but was significant in older patients (>55 years) (adjusted OR: 1.16, 95% CI: 1.09–1.23) after multivariable adjustment. Conclusions: Women with STEMI had poorer outcomes in terms of seeking medical assistance, receiving reperfusion therapy, and experiencing higher in-hospital mortality rates. Urgent investigation is needed to understand the underlying factors and develop strategies to improve healthcare access and outcomes for female STEMI patients.