Contemporary Trends and Age‐Specific Sex Differences in Management and Outcome for Patients With ST‐Segment Elevation Myocardial Infarction

Abstract

BackgroundAge‐ and sex‐specific differences exist in the treatment and outcome of ST‐elevation myocardial infarction (STEMI). We sought to describe age‐ and sex‐matched contemporary trends of in‐hospital management and outcome of patients with STEMI.Methods and ResultsWe analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age‐ and sex‐matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in‐hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07–1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07–1.93, P=0.009) were found to be significantly associated with in‐hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61).ConclusionsDespite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in‐hospital mortality than men, irrespective of age.

Sex and Outcomes After Percutaneous Coronary Intervention: A Cause for Concern for Young Women and Those With ST‐Segment Elevation Myocardial Infarction?

“…This report lends further (and stronger) support to earlier studies demonstrating a worse prognosis for women as compared with men with STEMI, and for younger women as compared with younger men . Even among a select group of patients referred for primary PCI (the guideline recommended reperfusion therapy for STEMI), women have a higher in‐hospital and 30‐day mortality than men and this is particularly notable among younger women as compared with younger men .…”

“…Bleeding and vascular complications are higher in women and are independent of baseline variables. Bleeding (and vascular complications) are associated with advanced age, lower body weight, and overdosing of anticoagulant medications, all of which are more common in women than men.…”

Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It's Time to Face Reality!

“…It is interesting to note that among patients with AMI, there is a higher prevalence of nonobstructive coronary arteries among women, particularly young women 25, 26, 27, 28, 29, 30. Nevertheless, the prognosis for young women with AMI is worse than that for young men 26, 29, 31, 32, 33, 34.…”

Acute coronary syndrome in elderly – risk factors and in-hospital outcome

“…Frailty also influences the rehabilitation. More aggressive management has been shown to improve the outcome of elderly patient following ACS [12], [13], [14].…”