Women with STEMI face more adverse CV events, higher mortality
Australian women with the deadliest type of heart attack, ST-segment elevation myocardial infarction (STEMI), are less likely to receive invasive treatment, revascularization or preventive medication at discharge, researchers reported in the Medical Journal of Australia.
The team, led by cardiologist Clara Chow, MBBS, PhD, of the Westmead Hospital in Sydney, also found that death rates and serious adverse cardiovascular events in women exhibiting STEMI were double the rates for men six months after discharge.
“Cardiovascular disease is the leading cause of morbidity and mortality in both sexes, but an extensive literature has described differences between men and women in clinical presentation and pathophysiology that may influence management and outcomes,” Chow and colleagues wrote. “Observational studies have found that women with acute coronary syndromes (ACS) more frequently present with atypical symptoms, with more comorbidities, and at an older age, and that plaque rupture and high-risk features are less likely to be identified during angiography than in men.”
Data from 2,898 patients were collected using the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) registry. Data from 2,183 men and 715 women were used in the final analysis to examine treatment and death disparities between male and female STEMI patients. The average age for women and men in the study cohort was 66 years and 60 years, respectively.
Women in the cohort had higher proportions of cardiovascular disease risk factors including hypertension, diabetes, prior stroke, chronic kidney disease, chronic heart failure and dementia. Fewer women had histories of previous coronary artery disease (CAD) or myocardial infarction (MI). The researchers found:
- Women were also less likely to have had percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
- Women were 47 percent less likely to have undergone coronary angiography or revascularization and were 58 percent less likely to have timely revascularization or primary PCI.
- Women were 28 percent less likely to receive timely revascularization and were 24 percent less likely to receive primary PCI.
- Six months after discharge, the rate of a major adverse cardiovascular event occurring was 2.86 times more in woman, and death rates for women were doubled.
- At discharge, significantly fewer women than men received beta blockers, statins and referrals to cardiac rehabilitation.
While the researchers noted that treatment protocols for STEMI patients have improved in Australia, gender-based disparities in management, treatment and mortality still exist. They called for research to determine whether differences in management are justified or if strategies are needed to address the disparities.
"The reasons for the under-treatment and management of women compared to men in Australian hospitals aren't clear,” Chow said in a prepared statement issued by the University of Sydney. “It might be due to poor awareness that women with STEMI are generally at higher risk, or by a preference for subjectively assessing risk rather than applying more reliable, objective risk prediction tools. Whatever the cause, these differences aren't justified. We need to do more research to discover why women suffering serious heart attacks are being under-investigated by health services and urgently identify ways to redress the disparity in treatment and health outcomes."
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.