Sex Differences in Presentation, Treatment and Outcomes in STEMI: a Ten Year Retrospective Study

Sex differences in cardiovascular disease remain poorly understood, which limits optimization of cardiovascular care for both sexes. We review the presentation, treatment and outcomes of women and men with ST elevation MI (STEMI) at our institution over a 10 year span.

Methods: Patients admitted to the CCU with a definite diagnosis of STEMI between 2005 -2015 were evaluated. Demographics, clinical data and outcomes were obtained from the hospital medical information system. Data was validated manually in 5% of patients.

Results: 311 women (average age 67) and 1536 men (average age 59) underwent STEMI during this period. Women were more frequently diabetic (40% vs. 26%, p<0.001,) hypertensive (68% vs 42%, p<0.001), and less frequently active smokers (22% vs 45%, p<0.001.) Significant differences between women and men were seen in the time from pain to hospital arrival (3.1 vs 2.4 hours, p=0.002) and from hospital arrival to balloon (0.7 vs. 0.5 hours, p=0.04.) Women who underwent catheterization were less likely to undergo PCI (94.9% vs 97.3%, p=0.026). During hospitalization, more women were diagnosed with heart failure (15% vs. 9%, p=0.002.). No differences were seen in location of MI, ejection fraction, acute renal failure, CVA, cardiogenic shock or sudden cardiac death. Upon discharge, women were less likely to receive aspirin (93% vs 97%, p = 0.006,) ACE or ARB (69% vs 76%, p=0.02) or statin therapy (92% vs 98%, p<0.001). In hospital (5.5% vs 2.3%, p = 0.003), 30 day (7.7% vs 2.5%, p <0.001) and one year mortality (14.1% vs 4.7%, p<0.001) were increased in women. Cox regression analysis revealed that sex continued to be predictive of mortality even after adjustment for age and diabetes (hazard ratio 0.67 (0.45-1.00), p=0.05).

Conclusion: In this cohort, sex differences were seen in the presentation, treatment and outcomes of STEMI in women when compared to men.