In STEMI, worse in-hospital outcomes for women vs. men
Among patients with STEMI, women have higher risk for in-hospital mortality, stroke, repeat MI and major bleeding compared with men, according to a meta-analysis published in The American Journal of Cardiology.
“As the care for STEMI patients has continued to improve globally, sex disparities in quality of care and outcomes have become more apparent. While some studies have showed that the higher mortality in women is largely due to differences in age, comorbidities, treatment strategy and reperfusion delays, others have found that the differences persist despite adjustment for these variables,” Tayyab Shah, MD, hospital resident at Yale University School of Medicine, and colleagues wrote. “Whether the sex disparities persist at a global level with the current widespread adoption of care systems for STEMI patients remains unknown.”
In a meta-analysis, researchers evaluated 56 studies of 705,098 patients (31% women) investigating sex-based discrepancies in patients with STEMI. Compared with men, women were older (70.2 years vs. 61.1 years), more often had diabetes (27.4% vs. 21%), more often had hypertension (61.1% vs. 50.6%), more often had prior stroke (8.1% vs. 7.4%) and were less likely to have primary PCI (59.5% vs. 68.2%).
Compared with men, women also experienced longer delays in time to first medical contact (mean delay, 42.5 minutes; 95% CI, 28.4-56.6; P < .00001) and door-to-balloon time (mean delay 4.9 minutes; 95% CI, 3.8-6.1; P < .00001).
Women compared with men had higher rates of mortality (OR = 1.91; 95% CI, 1.84-1.99; P < .00001), repeat MI (OR = 1.25; 95% CI, 1-1.56; P = .05), stroke (OR = 1.67; 95% CI, 1.27-2.2; P < .001) and major bleeding (OR = 1.82; 95% CI, 1.56-2.12; P < .00001).
The biggest contributor to the mortality discrepancy was older age in women, the researchers wrote.
“Despite improvements in STEMI care, women have rates of in-hospital mortality, stroke, repeat MI and major bleeding up to twofold higher than men,” Shah and colleagues wrote. “Sex disparities in in-hospital outcomes can largely be explained by differences in age, but patient comorbidities, delays to care and suboptimal treatment also contribute and are areas in need for improvement at the global level.”