Cenko E, et al. - Researchers assessed if the risk of 30-day mortality after ST-segment elevation myocardial infarction (STEMI) is higher in women than men and, if so, they evaluated the role of age, medications, and primary percutaneous coronary intervention (PCI) in this excess of risk. In women with STEMI, younger age was linked to higher 30-day mortality rates than seen in men, even after adjustment for medications, primary PCI, and other coexisting comorbidities. After age 60, this difference declines, and is not seen in the oldest group of women.

Methods

• A total of 8,834 patients were hospitalized and received medical treatment for STEMI from January 2010 to January 2016 in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry.
• Researchers recorded demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI.
• Inverse probability of treatment weighted (IPTW) logistic regression models were used to estimate adjusted 30-day mortality rates for the main outcome measure.

Results

• Researchers included 2,657 women with a mean (SD) age of 66.1 (11.6) years and 6,177 men with a mean (SD) age of 59.9 (11.7) years in the study.
• Significantly higher 30-day mortality was noted for women vs men (11.6% vs 6.0%, P < .001).
• Restricting the analysis to men and women undergoing primary PCI narrowed the gap in sex-specific mortality (7.1% vs 3.3%, P < .001).
• Women under 60 showed higher early mortality risk than men of the same age category after multivariable adjustment for comorbidities and treatment covariates (OR, 1.88; 95% CI, 1.04-3.26; P=.02).
• In the subgroups aged 60 to 74 years and over 75 years, the risk was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P=.19 and OR, 1.17; 95% CI, 0.80-1.73; P=.40; respectively).
• The relationship among sex, age category, and 30-day mortality was similar after IPTW adjustment for baseline clinical covariates (OR, 1.56 [95% CI, 1.05-2.3]; OR, 1.49 [95% CI, 1.15-1.92]; and OR, 1.21 [95% CI, 0.93-1.57]; respectively).