Unbalanced: Women die more often after STEMI PCI

Women are almost twice as likely as men to die of any cause in hospital after a STEMI-related primary PCI, according to a study published online Sept. 29 in JAMA: Internal Medicine. This disparity occurs in spite of increased awareness of modifiable risks, researchers wrote.

These finding appear to be in line with other sex-related survival studies, including one linking female sex to worse outcomes in STEMI and PCI published in August.

Samir Bipin Pancholy, MD, of Commonwealth Medical College and Wright Center for Graduate Medical Education in Scranton, Penn., and colleagues analyzed 35 historical studies comparing men and women who had STEMI and subsequent PCI. Research used in this meta-analysis was inclusive of studies published through April 13, 2014.

The research team found that in addition to women facing a 1.93 risk ratio for in-hospital all-cause mortality, women also bore a significantly higher risk of one-year all-cause mortality. Women were 1.58 times more likely to die within one year of primary PCI from any cause than their male counterparts.

They also noted that women were more likely to be older, have a greater comorbid burden than their male counterparts and women with STEMI were in poorer relative cardiovascular health than men.

“Health care utilization among women has often been found to be suboptimal compared with men presenting with STEMI,” Pancholy et al wrote. Women were less likely to receive thrombolysis or primary reperfusion therapy and were less likely to get newer therapies when seeking medical care for STEMI.

Despite being sicker, women also were more likely to have missed STEMI diagnoses prehospitalization and were more likely to get delays to reperfusion and lower priority for emergency services when being transported with possible STEMI.

“While the reasons for these demonstrated disparities are unclear, they could easily contribute to increased mortality, both in-hospital and long term, in women presenting with STEMI,” Pancholy et al wrote.

This highlights ongoing disparity in medical research and treatment, as many studies are still white male-heavy, leaving women, minorities and the elderly with little observable data to back guidelines that have implications for their care as well. In those few studies that do observe these underserved groups, higher risks and differences in presentation have been shown to affect outcomes.

In a related research letter, Muhammad Rizwan Sardar, MD, of Main Line Health System in Wynnewood, Penn., and colleagues wrote that clinical trials that influence guideline development must include minorities, women and elderly patients “to improve the evidence base for patient care as well as the professional society guidelines.”

Their analysis showed that while the inequality and homogeneity of studies that influenced guideline development for atrial fibrillation, heart failure and STEMI/unstable angina have improved, there were still too few underrepresented patients to gain a full picture of health and outcomes, other than to say that their outcomes were poorer.

Both Sardar et al and Pancholy et al wrote about a need to stimulate more research and to have that research applied to developing improved, evidence-based best practices that work for all patients.