Sex-specific differences in management and treatment in ST-elevation myocardial infarction – a German nationwide real-life analysis. (14th October 2021)

• Record Type: Journal Article
• Authors: Kuehnemund, L; Koeppe, J; Fischer, A J; Feld, J; Illner, J; Makowski, L; Engelbertz, C; Gerss, J; Droege, P; Guenster, C; Reinecke, H; Freisinger, E
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Cardiovascular Disease in Women; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.2779
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background/Introduction: Acute myocardial infarction (AMI) continues to be the leading cause of death in men and women worldwide. The outcome of patients with AMI improved during the last years but the impact of sex is under current debate since female sex has repeatedly to be associated with an unfavourable outcome in AMI. Purpose: This retrospective routine-data-based analysis sought to examine sex differences of recent trends in in-patient healthcare and outcome of ST-elevation myocardial infarction (STEMI). Methods: The dataset of the Federal Association of the Local Health Insurance Funds was used to identify patients who were hospitalized for STEMI in Germany between January 2010 and December 2017. Further, data on concomitant diseases, risk constellations, selected cardiovascular procedures, as well as in-hospital and 30-days mortality were assessed and further analyzed with regard to sex differences. Results: In total, we identified 175, 187 STEMI patients over the 8-year period, thereof about 35% female patients. Women with STEMI were older (median (interquartile range (IQR)): 76 (19) vs. 64 (20) years in men) and had more comorbidities including diabetes (44.9% vs. 35.5%), hypertension (90.9% vs. 82.8%), congestive heart failure (54.7% vs. 43.8%) and chronic kidney disease (33.5% vs. 22.3%); all p<0.001). Further, female STEMI patients underwent less often percutaneous coronary intervention during hospitalization (PCI; 75.5% vs. 85.2%; p<0.001). Complications such as shock (14.8% vs. 13.0%) and bleeding (9.3% vs. 6.6%; both p<0.001) could be observed more frequently in women. Female sex was independently associated with a higher adjusted 30-day mortality (Odds Ratio 1.08; CI 1.05–1.12; p<0.001). Conclusion: In a contemporary unselected cohort, one-third of STEMI patients are female. Women with STEMI are older with higher cardiovascular risk, and continue to receive less likely interventional revascularization therapy compared to male STEMI patients. Moreover, female STEMI patients were observed higher complications and death during index hospitalization and 30 days thereafter. Further analyses are urgently needed to identify causes of under-treatment and impaired outcome in women with STEMI. Funding Acknowledgement: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): joint federal committee, Germany.