STEMI outcomes continue to be considerably worse for women than men, according to a review of more than 56 different studies. This appears to be true throughout the world.
The new meta-analysis, published in the American Journal of Cardiology, covers more than 705,000 STEMI patients from 30 countries who received care from January 2000 to December 2019. Thirty-one percent of patients were women.
Overall, researchers found that women were associated with longer delays to first medical contact and longer door-to-balloon times. In-hospital rates of mortality, repeat myocardial infarction, stroke and major bleeding events were all also much higher for women.
Another key takeaway from this new meta-analysis is that women received less optimal STEMI therapy during hospitalization. For example, the rates of primary percutaneous coronary intervention (59.5% vs. 68.2%), aspirin use (89.5% vs. 92.1%) and P2Y12 inhibitors use (67.6% vs. 75.4%) were all lower among women than they were among men.
“Overall the global findings were consistent across the regions,” wrote first author Tayyab Shah, MD, a cardiovascular medicine specialist at Yale University School of Medicine, and colleagues. “Sex-disparities in in-hospital mortality were observed in all regions and did not spare North America or Europe where the systems of care are well-established.”
Looking closer at the data, Shah et al. did provide some possible reasons for these trends. The delays in patient care, for instance, may be tied to the ways that STEMI symptoms present—and how men respond to those symptoms compared to how women respond.
“These delays are likely the result of female STEMI patients being more likely to experience atypical symptoms (i.e. back, shoulder, and/or stomach pain rather than chest pain) and males being more likely to believe that their symptoms are cardiac in nature with bystanders more readily encouraging them to call emergency medical services than females who often attribute symptoms to anxiety, even when they have chest pain,” the authors wrote. “Given that women tend to be less reluctant to utilize medical services, raising the awareness of the public and health professionals regarding STEMI presentation in females may help to reduce delays to care.”
In addition, the team added, women often present with myocardial infarctions a full five to ten years later than men because estrogen is known to delay the development of cardiovascular disease in premenopausal females.
Even with these potential reasons in mind, the authors did conclude that there is work to be done. “Patient comorbidities, delays to care and suboptimal treatment,” they wrote, “are areas in need for improvement at the global level.”
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