Abstract 17623: Ten-Year Trends in Sex-differences of Treatments and Mortality in ST-elevation Acute Myocardial Infarction in Northern Italy, 2000-2010
Background: Women are at high risk for mortality after ST-elevation acute myocardial infarction (STEMI). Whether sex-disparities still exist in the treatment and mortality of patients after STEMI remains controversial.
Objectives: The aim of this study was to assess recent trends in hospital mortality and in treatment modalities for patients with STEMI according to sex.
Methods: Data on hospitalizations for STEMI from 2000 through 2010 were extracted from hospital discharge record databases from all hospitals in Lombardia (a Northern Italy region with high density population). Main outcome measures were in-hospital mortality and treatment modality by sex. Treatment modalities included medical therapy alone or an invasive approach, the latter consisting of coronary angiography alone, percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery. Multivariable logistic regression was performed to assess the impact of female sex and of treatment modality on mortality after adjusting for age, and comorbidities.
Results: A total of 92807 patients with STEMI, 66.4% men and 33.6% women were enrolled. Women were older than men (mean 75.1 yrs vs 64.1 yrs, p<0.0001) and had a higher prevalence of chronic renal failure (p<0.001). In-hospital mortality presented a small decrease from 7.5% in 2000 to 6.3% in 2010 among men, while it remained higher and substantially constant over time among women (16.4% in 2000, 16.2% in 2010). The use of an invasive approach increased over time in both sexes (from 55% in 2000 to 91% in 2010 in men and from 36% in 2000 to 70% in 2010 in women). The use of PCI increased from 32% in 2000 to 82% in 2010 in men; and from 21% in 2000 to 57% in 2010 in women. At multivariable regression, an invasive approach (odds ratio (OR) 0.23, 95% confidence interval (CI), 0.21-0.25, p<0.001) was associated with a significant reduction in mortality, while female sex was not a predictor of mortality (OR 0.96, P=0.18).
Conclusions: A weak temporal trend in mortality reduction is observed among men only. In-hospital mortality remains higher in women than in men, although female sex is not a significant predictor of mortality. Despite temporal increases in the use of an invasive approach, women are more often treated conservatively.
- © 2013 by American Heart Association, Inc.