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Early invasive strategy not related to sex differences in in-hospital mortality in non-STEMI
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In patients with non-STEMI, the lower use of early invasive techniques is not responsible for higher crude in-hospital mortality rates among women, possibly due to older age and higher comorbidity burden, according to results published in Circulation: Cardiovascular Interventions.
“With rapid advances in pharmacotherapies for CAD and associated risk factors, the incidence of and mortality associated with acute myocardial infarction has declined in the last several years,” Tanush Gupta, MD, from the division of cardiology, Montefiore Medical Center at the Albert Einstein College of Medicine, and colleagues wrote. “Prior studies have shown that women with non-STEMI also experience higher in-hospital mortality compared with men. However, it is not completely understood whether the higher mortality in women is driven by worse baseline risk profile or sex-based disparities in treatment.”
Using the National Inpatient Sample databases from 2003 to 2014, Gupta and colleagues identified 4,765,739 adult patients hospitalized with the principal diagnosis of non-STEMI (42.5% women). They examined sex differences in use of an early invasive strategy, defined as CABG or angiography with or without PCI, and in-hospital mortality.
The researchers found that women:
- were on average 6 years older than men;
- had a greater burden of comorbidities;
- were less likely to be treated with an early invasive strategy (29.4% vs. 39.2%; adjusted OR = 0.92; 95% CI, 0.91–0.94);
- had higher crude in-hospital mortality than men (4.7% vs. 3.9%; unadjusted OR = 1.22; 95% CI, 1.2-1.25); and
- had 10% lower odds of in-hospital mortality (aOR = 0.9; 95% CI, 0.89-0.92) after adjustment for age, comorbidities, other demographics and hospital characteristics.
The researchers also found that the link between female sex and lower risk-adjusted in-hospital mortality did not change after adjustment for differences in the use of an early invasive strategy.
“These data provide important insights into the underlying reasons for the higher mortality observed in women with [non-]STEMI,” the researchers wrote. “Our findings should also provide impetus to quality initiatives to mitigate the higher observed mortality in younger women with [non-]STEMI.”– by Dave Quaile
Disclosures: Gupta reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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