Sex Differences in Outcomes of STEMI in Younger Adults

Study Questions:

What are the temporal trends and sex differences in revascularization and in-hospital outcomes of younger patients with ST-segment elevation myocardial infarction (STEMI)?

Methods:

The investigators used the 2004-2011 Nationwide Inpatient Sample databases to identify all patients ages 18-59 years hospitalized with STEMI. Temporal trends and sex differences in revascularization strategies, in-hospital mortality, and length of stay (LOS) were analyzed.

Results:

From 2004 to 2011, of 1,363,492 younger adults (ages <60 years) with acute myocardial infarction (AMI), 632,930 (46.4%) had STEMI. Younger women with AMI were less likely than men to present with STEMI (adjusted odds ratio [OR], 0.74; 95% confidence interval [CI], 0.73-0.75). Younger women with STEMI were less likely to receive reperfusion as compared to younger men (adjusted OR for percutaneous coronary intervention [PCI], 0.74; 95% CI, 0.73-0.75; OR for coronary artery bypass grafting, 0.6; 95% CI, 0.60-0.62; OR for thrombolysis, 0.80; 95% CI, 0.78-0.82). From 2004 to 2011, utilization of PCI for STEMI increased in both younger men (63.9% to 84.8%, ptrend < 0.001) and women (53.6% to 77.7%, ptrend < 0.001). In-hospital mortality was significantly higher in younger women compared to men (4.5% vs. 3.0%, adjusted OR, 1.11; 95% CI, 1.07-1.15). There was an increasing trend in risk-adjusted in-hospital mortality in both younger men and women in the study period. Length of stay decreased in both younger men and women (ptrend < 0.001).

Conclusions:

The authors concluded that younger women are less likely to receive revascularization for STEMI and have higher in-hospital mortality as compared to younger men.

Perspective:

This study reports that younger women with STEMI were less likely to receive revascularization and had higher unadjusted and risk-adjusted in-hospital mortality as compared to men. These disparities in care provide an opportunity to improve national STEMI care processes and outcomes, and eliminate the sex disparity in providing care to younger patients with STEMI. Additional prospective studies are indicated to better understand the factors responsible for sex-related disparities in revascularization and outcomes in patients with STEMI, and to develop strategies to address those issues.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Cardiac Surgery and CHD & Pediatrics, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and ACS

Keywords: Acute Coronary Syndrome, Coronary Artery Bypass, Hospital Mortality, Myocardial Infarction, Percutaneous Coronary Intervention, Myocardial Reperfusion, Myocardial Revascularization, Percutaneous Coronary Intervention, Risk, Young Adult


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