Influence of gender on delays and early mortality in ST-segment elevation myocardial infarction: Insight from the first French Metaregistry, 2005–2012 patient-level pooled analysis

Abstract

This overview of 16,733 real-life consecutive STEMI patients in prospective registries over an extensive period strongly indicates gender-related discrepancies, highlighting clinically relevant delays in seeking medical attention. However, higher in-hospital mortality was not totally explained by clinical characteristics or delays. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.

Evaluation of sex differences in patients with ST-elevated myocardial infarction: an observational cohort study in Amsterdam and surrounding region

“…A European multinational registry showed women to be 5% more likely than men (75.9% vs 70.4%) to present to a hospital after more than 120 min from symptom onset [ 4 ]. In a French meta-registry, patient delay in women was significantly longer than in men by a mean of 14 min [ 2 ]. A Dutch study by Velders et al.…”

“…The all-cause short-and long-term hazard ratio was higher amongst women, yet did not reach statistical significance, which is in contrast to the findings of previous research. In the literature, women present with more explicit cardiovascular risk profiles compared to men [ 3 , 18 , 20 ], which likely explains their elevated early [ 2 , 3 , 5 , 6 , 19 , 21 ] and 1‑year [ 6 , 22 ] mortality rates following pPCI. Concerning risk factors, the current study reports only on differences in the prevalence of hypertension and smoking status.…”

“…Countries like France, Sweden and the UK have comparable logistics. Results show that the median total ischaemic time (symptom-to-balloon time) for pPCI for men and women combined is shortest in the UK (230 min) [ 6 ], followed by the Netherlands (314 min), Sweden (345 min) [ 6 ] and France (385 min) [ 2 ]. However, this comparison includes patient delay, which is subjective and ideally would have covered the time span from ECG diagnosis until arterial access/balloon inflation.…”

“…In 28% of the total study population pPCI was performed after 120 min or more, and according to the ESC guidelines a pharmaco-invasive strategy would have been the preferred form of treatment. Patients who present with an OHCA after suffering STEMI have often been excluded from other studies [ 1 , 2 , 17 ] or only included after re-establishment of circulation [ 7 ]. However, in this study the OHCA group was not excluded to achieve the main goal, namely comparing STEMI management between women and men.…”

“…In Europe, patient delay [ 1 – 3 ] and overall ischaemic time [ 4 ] are reported to be longer in women. Women experience higher in-hospital [ 2 , 3 , 5 ] 30-day [ 4 ] and 1‑year [ 6 ] death rates than men. In various parts of the Netherlands women have been shown to have increased total ischaemic times compared to men [ 7 ] and (young, [ 8 ]) women had increased mortality rates following STEMI when compared to similarly aged men [ 9 ].…”