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STEMI mortality rates tied to women’s age

Women aged younger than 60 years who were hospitalized for ST-segment elevation myocardial infarction had a higher risk for 30-day mortality, according to research published in JAMA Internal Medicine.

“Previous works have shown that women hospitalized with ST-segment elevation myocardial infarction (STEMI) have higher short-term mortality rates than men,” Edina Cenko, MD, PhD, from the University of Bologna, Italy, and colleagues wrote. “However, it is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI).”

Cenko and colleagues analyzed data from the International Survey of Acute Coronary Syndromes in Transitional Countries to determine whether the risk of 30-day mortality after STEMI differed by sex, and how age, medications and primary PCI affected the risk. The researchers enrolled 8,834 patients who received treatment at a hospital for STEMI between January 2010 and January 2016. Participants consisted of 2,657 women (mean age, 66.1 years) and 6,177 men (mean age, 59.9 years).

The analysis indicated that women had a significantly higher 30-day mortality risk than men (11.6% vs. 6%). After limiting the evaluation to participants undergoing primary PCI, the disparity in sex-specific mortality shrunk to 7.1% for women and 3.3% for men.

Early mortality risk was higher among women aged younger than 60 years than among men in the same age cohort when adjusting for medications and other comorbidities (OR = 1.88; 95% CI, 1.04-3.26). Sex differences in 30-day mortality risk were not significant among participants aged 60 to 70 years (OR = 1.28; 95% CI, 0.88-1.88) and those aged older than 75 years (OR = 1.17; 95% CI, 0.8-1.73).

When the researchers performed inverse probability of treatment weighted adjustments for baseline clinical covariates, they found that there were similar associations between sex (OR = 1.56; 95% CI, 1.05-2.3), age category (OR = 1.49; 95% CI, 1.15-1.92) and 30-day mortality (OR = 1.21; 95% CI, 0.93-1.57).

“The current study is the first investigation which demonstrates that differences between younger men and younger women in STEMI mortality rates are unrelated to disparities in treatment,” Cenko and colleagues concluded. “This holds true even in patients undergoing primary PCI. Sex-related pathophysiological differences may contribute to the higher mortality in younger women compared with men of the same age category.” – by Alaina Tedesco

Disclosure s : The authors report no relevant financial disclosures.