Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries

Abstract

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.

Sex differences in treatment and outcomes amongst myocardial infarction patients presenting with and without obstructive coronary arteries: a prospective multicentre study

“…We saw no difference in the adjusted odds of mortality for females diagnosed with MIOCA at long term, consistent with others with longer-term follow-up up to 10 years. 27 As observed previously, 11 , 17 , 28 , 29 this study supports the finding that in the context of MIOCA, females have a greater risk factor and comorbidity burden and are less commonly prescribed secondary prevention pharmacotherapy than males, which may contribute to these findings.…”

“…Furthermore, we have observed that females diagnosed with MIOCA received significantly fewer discharge medications than men, a trend recently observed in a Europe-wide study. 17 We have recently shown that if females and males are provided with guideline-recommended therapy equally, then the long-term outcomes are similar between the sexes. 18 …”

Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes

“…Undertreatment and higher mortality in women with ST-segment elevation MI, non-ST-segment elevation MI or unstable angina have repeatedly been described during the past 20 years 72 . Despite increasing awareness of gender inequalities in the management of patients with ACS in Europe, a study published in 2022 using country-level data from four European countries confirmed that women still receive guideline-recommended therapies less often than men and have a higher mortality that persists after multivariate adjustment for known cardiovascular risk factors, including age 74 . Outcomes, including mortality, are worst among women aged <50 years, who are less likely to have ACS than men or older women 72 , 75 .…”

Remote ischaemic conditioning: defining critical criteria for success—report from the 11th Hatter Cardiovascular Workshop

“…This suggests that these clinical studies using patients in countries with well-established cardiac coronary care, are of such low risk that additional therapy is unlikely to demonstrate any further benefit in outcome. This is despite the fact that, outside of clinical studies , mortality rates for hospitalized STEMI patients in Europe remain in the region of 15–25% [ 38 ], which demonstrates that there clearly remains a need for cardioprotective strategies, even if it is difficult to demonstrate in this population. A solution to this quandary may be to undertake future studies using this low-cost intervention in developing countries, where presenting patients are at significantly higher risk [ 10 , 35 , 47 ].…”