Five years of a comprehensive ST-elevation myocardial infarction protocol and its association with sex disparities

Abstract

Aims To determine whether a comprehensive STEMI protocol is associated with reduced sex disparities over 5 years. Methods and Results This was an observational cohort study of 1833 consecutive STEMI patients treated with percutaneous coronary intervention (PCI) before (1/1/2011-7/14/2014, control group) and after (7/15/2014-7/15/2019, protocol group) implementation of a protocol for early guideline-directed medical therapy (GDMT), rapid door to balloon time (D2BT), and use of trans-radial PCI. In the control group females had less GDMT (77.1% vs. 68.1%, p = 0.03), similarly low trans-radial PCI (19.0% vs. 17.6%, p = 0.73), and longer D2BT(104 min [79, 133] vs. 112 min [85, 147], p = 0.02) corresponding to higher in-hospital mortality (4.5% vs. 10.3%, OR 2.44 [1.34-4.46], p = 0.004), major adverse cardiac and cerebrovascular events (MACCE, 9.8% vs. 16.3%, OR 1.79 [1.14-2.84], p = 0.01), and net adverse clinical events (NACE, 16.1% vs. 28.3%, OR 2.06 [1.42-2.99], p < 0.001). In the protocol group, no significant sex differences were observed in GDMT (87.2% vs. 86.4%, p = 0.81) or D2BT (85 min [64, 106] vs. 89 min [65, 111], p = 0.06) but trans-radial PCI was used less in females (77.6% vs. 71.2%, p = 0.03). In-hospital mortality (2.5% vs. 4.4%, OR 1.78 [0.91-3.51], p = 0.09) and MACCE (9.0% vs. 11.0%, OR 1.27 [0.83-1.92], p = 0.26) were similar between sexes, but higher NACE in females approached significance (14.8% vs. 19.4%, OR 1.38 [0.99-1.92], p = 0.05) due to higher bleeding risk (7.2% vs. 11.1%, OR 1.60 [1.04-2.46], p = 0.03). Conclusions A comprehensive STEMI protocol was associated with sustained reductions for in-hospital ischemic outcomes over 5 years, but higher bleeding rates in females persisted.

Highlights from 2022 in EHJ Open

“…Coronary Artery Disease ( Section and Deputy Editor Maciej Banach ) as well as Interventional Cardiology and Cardiac Surgery ( Section and Social Media Editor Salvatore De Rosa ) highlight sex-differences, which was one of the subjects also marking the previous year with EHJ Open. 7 A comparison within four European registries revealed sex-related differences in ST-elevation myocardial infarction (STEMI). 8 Women underwent angiography, PCI, and echocardiography to a lesser extent than men and also received less guideline-recommended post-STEMI therapies.…”