Gender disparities in ST-segment elevation myocardial infarction (STEMI) outcomes
continue to be reported worldwide; however, the magnitude of this gap remains unknown.
To evaluate gender-based discrepancies in clinical outcomes and identify the primary
driving factors a global meta-analysis was performed. Studies were selected if they
included all comers with STEMI, reported gender specific patient characteristics,
treatments, and outcomes, according to the registered PROSPERO protocol: CRD42020161469.
A total of 56 studies (705,098 patients, 31% females) were included. Females were
older, had more comorbidities and received less antiplatelet therapy and primary percutaneous
coronary intervention (PCI). Females experienced significantly longer delays to first
medical contact (mean difference 42.5 min) and door-to-balloon time (mean difference
4.9 min). In-hospital, females had increased rates of mortality (odds ratio [OR] 1.91,
95% confidence interval [CI] 1.84 to 1.99, p <0.00001), repeat myocardial infarction
(MI) (OR 1.25, 95% CI 1.00 to 1.56, p=0.05), stroke (OR 1.67, 95% CI 1.27 to 2.20,
p <0.001), and major bleeding (OR 1.82, 95% CI 1.56 to 2.12, p <0.00001) compared
with males. Older age at presentation was the primary driver of excess mortality in
females, although other factors including lower rates of primary PCI and aspirin usage,
and longer door-to-balloon times contributed. In contrast, excess rates of repeat
MI and stroke in females appeared to be driven, at least in part, by lower use of
primary PCI and P2Y12 inhibitors, respectively. In conclusion, despite improvements
in STEMI care, women continue to have in-hospital rates of mortality, repeat MI, stroke,
and major bleeding up to 2-fold higher than men. Gender disparities in in-hospital
outcomes can largely be explained by age differences at presentation but comorbidities,
delays to care and suboptimal treatment experienced by women may contribute to the
gender gap.
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Article info
Publication history
Published online: February 24, 2021
Received in revised form:
February 6,
2021
Received:
December 14,
2020
Identification
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