Background Data on how differences in risk-factors, treatments and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST elevation myocardial infarction (STEMI) patients in different European countries. Methods Patients over the age of 18 with STEMI who were treated in hospitals in 2014–2017 and registered in one of the national myocardial infarction registers in Estonia (n = 5,817), Hungary (n = 30,787), Norway (=33,054) and Sweden (n = 49,533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic- and cox regression was used to study the associations of sex and outcomes in the respective countries. Results Women were older than men (70-78 years and 62-68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality rates in-hospital (10.9-15.9% and 6.5-8.9%, respectively), at 30 days (13.0-19.9% and 8.2-10.9%, respectively), and at one year (20.3-28.1% and 12.4-17.2%, respectively) after hospitalization were higher in women versus men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for one year mortality. Conclusion Despite improved awareness of the sex-specific inequalities on managing AMI patients in Europe, country level data from this study show that women still receive less guideline-recommended management.
Introduction Women receive less evidence-based care than men and have higher mortality after myocardial infarctions than men. But it is not known how the gender difference in risk factors, treatments and outcomes differs between European countries. Purpose In order to investigate the gender differences in European countries with different economic predispositions we aimed to describe and compare baseline characteristics, in-hospital management, medications at discharge and death outcomes of man and woman ST-elevation infarction (STEMI) patients following routine clinical practice in Sweden, Norway, Hungary and Estonia. Methods The study population is patients over the age of 18 with STEMI who were treated in hospital 2014–2017 (for Norway between 2013–2016) and registered in one of the national myocardial infarction registers. Patients with non-ST elevation infarction and unstable angina were excluded. Risk factors, hospital treatment, and prescription medications were obtained from the national myocardial infarction registries from each country. Mortality in-hospital, after 30 days and after 1 year, was obtained from national death registers. Results Women were on average older, had more comorbidities and higher mortality in hospital, after 30 days and one year after hospitalization. Women received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men. Conclusions The study illustrates that there are differences in characteristics, management, treatments and outcomes between men and women in all of the studied countries no matter economic predispositions. Generally, women are treated with guideline recommended therapy to a lesser extent than men in the studied countries. Funding Acknowledgement Type of funding sources: None.
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