In STEMI, women less likely than men to receive PCI, survive to 1 year in India
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Key takeaways:
- Among patients with STEMI in India, women did not receive PCI as often as men.
- Women had a more than twofold higher mortality risk at 1 year than men.
- The findings raise questions about issues like PCI access.
Among patients with STEMI in India, women were less likely to receive PCI and more likely to die at 1 year than men, researchers reported in JACC: Asia.
“While remarkable progress has been made in the high-income countries for the treatment of STEMI, the timely care of STEMI remains behind in India,” Arman Qamar, MD, MPH, RPVI, FACC, interventional cardiologist and auxiliary research scholar at NorthShore Cardiovascular Institute, NorthShore Health System, Evanston, Illinois, told Healio. “Most patients with STEMI in India do not receive timely PCI and suffer complications of MI like death or heart failure. We started this analysis to evaluate the current practice patterns and sex differences in the treatment of STEMI in India.”
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The researchers analyzed 3,635 patients from the NORIN-STEMI registry in India (16% women; mean age, 55 years).
Among the cohort, one-third were younger than 50 years, the median time from symptom onset to coronary angiography was 71 hours, 93% first presented to a facility without PCI capability and 46% had left ventricular ejection fraction less than 40%.
Nearly all patients received aspirin, a statin, a P2Y12 inhibitor and heparin upon presentation, but only 66% underwent PCI (98% with femoral access), the researchers wrote, noting 13% received fibrinolytics.
The mortality rate at 30 days was 9% and the mortality rate at 1 year was 11%, according to the researchers.
Compared with men, women were less likely to receive PCI (62% vs. 73%; P < .0001) and more likely to die at 1 year (22% vs. 9%; adjusted HR = 2.1; 95% CI, 1.7-2.7; P < .001), Qamar and colleagues wrote.
“Women have delayed diagnosis of MI [and] many believe this may be due to atypical symptoms,” Qamar told Healio. “Additionally, it is well known that there are major disparities in health care access in women as compared to men. Unfortunately, it is well known that in countries like India, the health of men is prioritized over [that of] women.”
The mortality rates in the study are more comparable to those in other low-income countries than to those in the U.S., but women receiving suboptimal STEMI care compared with men is also an issue in the U.S., he said.
“The following will help improve STEMI care in India: Increase awareness of symptoms and timely diagnosis of MI, increase access to primary PCI by making more cath labs across the country and increase government funding for cardiovascular care across the country,” Qamar told Healio.
For more information:
Arman Qamar, MD, MPH, can be reached at aqamar@northshore.org; Twitter: @aqamarmd.
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