Data suggest worse outcomes for women after in-hospital STEMI
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Women are more likely to have an in-hospital vs. out-of-hospital STEMI, with women experiencing an average 10‐minute delay from symptom onset to reperfusion compared with men, according to an analysis of registry data.
“Rapid reperfusion is key in the treatment of STEMI, with time from symptom onset to revascularization closely linked to outcomes,” Julia Stehli, MD, a doctoral student at Monash University School of Nursing and Health Sciences in Melbourne, Victoria, Australia, and colleagues wrote in the study background. “Two groups of patients with STEMI who demonstrate a particularly poor prognosis are females and patients with so‐called ‘in‐hospital STEMI,’ that is, STEMI that happens while the patient is already admitted to the hospital. With regard to females, factors associated with poorer outcomes include significantly longer ischemic times in females compared with males as well as more bleeding and less guideline-directed medical therapy.”
Stehli and colleagues analyzed data from 7,493 patients with STEMI (6.6% in-hospital) who underwent PCI, prospectively recruited from 30 hospitals into the Victorian Cardiac Outcomes Registry (2013-2018). Researchers compared sex differences of in‐hospital vs. out‐of‐hospital STEMIs. The primary endpoint was 12‐month all‐cause mortality; secondary endpoints included symptom‐to‐device time and 30‐day major adverse CV events.
Within the cohort, women experienced 31.9% of in‐hospital STEMIs and 19.9% of out-of-hospital STEMIs.
Compared with men, women who experienced an in‐hospital STEMI were older (mean age, 69.5 years vs. 65.9 years; P = .003) with longer adjusted geometric mean symptom-to-device times (104.6 vs. 94.3 minutes; P < .001).
“Only 27% of female in‐hospital STEMI patients achieved a symptom-to-device time of 70 minutes compared with 32% of male patients,” the researchers wrote. “Only 44% of female in‐hospital STEMI patients achieved a symptom-to-device time 90 minutes compared with 49% of male in‐hospital STEMI patients.”
Researchers did not observe a between-sex difference in 12-month mortality for in-hospital STEMI (27.1% vs. 20.3%; P = .92) or major adverse CV events (22.8% vs. 19.3%; P = .87). Female sex was not independently associated with 12‐month mortality for in‐hospital STEMI, which was consistent across the STEMI cohort (OR = 1.26; 95% CI, 0.94-1.7; P = .13).
“Female in‐hospital STEMI patients had higher absolute rates of major adverse CV events, major adverse CV and cerebrovascular events, all‐cause mortality and major bleeding; however, they did not reach statistical significance, likely due to the small sample size,” the researchers wrote.
The researchers noted that the registry does not provide data about the condition for which patients with in‐hospital STEMI were hospitalized and therefore cannot assess the impact of this on survival.
“Raising awareness of sex differences in this understudied population of patients with in‐hospital STEMI is required to improve outcomes and further narrow the gap,” the researchers wrote.
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