Higher short-term mortality demonstrated for women compared with men after ST-elevation myocardial infarction

1. In a modern cohort of patients with readily available primary percutaneous coronary intervention, woman experienced greater mortality rates then men following ST-elevation myocardial infarction.

2. The greater mortality was only apparent in younger patients, under the age of 60 years.

Evidence Rating Level: 2 (Good)

Study Rundown: Prior studies have demonstrated significant differences in outcomes following acute myocardial infarction for men and women, with a trend for higher mortality amongst young women. Whether the observed differences are present for ST-elevation myocardial infarction (STEMI) with the availability of primary percutaneous coronary intervention (PCI) is not known. The current study sought to evaluate short-term outcomes for patients with STEMI depending on the sex, age, and primary method of management. The study found that women had a significantly higher 30-day mortality rate compared to men overall, and for those management with PCI. The effect of age on the differences in outcome between sexes was substantial, with the greatest difference in women less then 60 years of age.

Further work will be required to elucidate the exact mechanism of the observed differences. Some purported explanations include delays in diagnosis due to atypical presentations, smaller diameter arteries and fewer collateral vessels, and differences in important comorbidities. The strengths of this study include its large size, multinational design, and modern cohort. The main limitations of this study include its observational design and possible referral bias for only including PCI-capable centers.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

In-Depth [retrospective cohort]: This study used a large international observational database to collect data on patients diagnosed with STEMI between 2010 and 2016. The study used multivariate analysis to account for age, sex, primary therapy type, medications at time of diagnosis, and comorbidities.

Of the 8834 patients included the in study, 2657 were women. The mortality at 30 days was significantly higher for women than men (11.6%vs 6.0%, p < 0.001), even when only including patients who underwent PCI (7.1%vs 3.3%, p < 0.001). The difference in mortality was present for patients under the age of 60 years (OR, 1.88; 95%CI, 1.04-3.26; p = 0.02), while differences between sexes in older age groups were not observed.

Image: PD

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