Abstract 15500: Persistent Gender Bias in Use of Reperfusion Therapy in STEMI Patients: Data from the FAST-MI Program 1995-2010
Introduction: Previous studies have shown that women receive less reperfusion therapy for STEMI. To determine whether this gender bias persists over time, we assessed 15-year trends in use of primary PCI and reperfusion therapy, and one-year mortality in women (W) vs men (M) presenting with STEMI.
Methods: The FAST-MI program consists of 4 one-month nationwide French surveys conducted 5 years apart from 1995 to 2010, with a similar methodology and including all AMI patients admitted to general, academic or private hospitals.
Results: Of the 6707 STEMI patients included, 1811 were W (27%). Mean age decreased in W (74±12 to 71±15 years, P=0.006) as in M (63±14 to 61±14 years, P<0.001), and % of W <55 years doubled (from 8.4% to 17.5%). Management evolved regardless of sex: primary PCI increased from 7% to 56% in W and from 14% to 62% in M, while fibrinolysis decreased from 25.5% to 12% (W) and from 42% to 14.5% (M). Early use of recommended medications significantly increased in W and M: antiplatelet (W: 88% to 96%; M: 94% to 98%), low molecular weight heparin (W: 0 to 58%; M: 0 to 64%), beta-blockers (W: 51.5% to 74.5%; M: 70.5 to 83%), ACE-I (W: 44% to 55%; M: 49% to 62%) and statins (W: 6% to 86%; M: 11% to 91%). In the overall cohort, reperfusion therapy was less used in W (adjusted OR vs M: 0.75, 0.70-0.85), and the trend did not substantially change over time (OR: 0.63, 0.47-0.83 in 1995, and 0.74, 0.55-0.99 in 2010).
One-year mortality (Fig 1) decreased from 29% to 14% in W (HR adjusted on baseline profile 2010 vs 1995: 0.52, 0.37-0.74, P<0.001), and from 14% to 6% in M (adjusted HR 0.40, 0.29-0.54, P<0.001). Use of primary PCI was associated with lower one-year mortality both in W (adjusted HR 0.63, 0.45-0.90, P=0.01) and M (adjusted HR 0.74, 0.57-0.96, P=0.02).
Conclusion: Reperfusion therapy is associated with lower one-year mortality regardless of sex, but remains underused in women. Avoiding this persistent gender bias would likely result in further improving survival in women.
Author Disclosures: T. Simon: None. E. Puymirat: Speakers Bureau; Modest; AstraZeneca, Eli Lilly, Servier. Consultant/Advisory Board; Modest; AstraZeneca, Eli-Lilly, Servier. M. Zeller: Honoraria; Modest; MSD, Sanofi. F. Schiele: Consultant/Advisory Board; Modest; AstraZeneca, Eli Lilly, GSK, Sanofi, Servier, Takeda. S. Charpentier: Speakers Bureau; Modest; AstraZeneca, Brahms Thermofischer, Daiichi Sankyo, Eli Lilly, Medicines Company, Radiometer, Roche Diagnostics, Sanofi. Consultant/Advisory Board; Modest; AstraZeneca, Eli Lilly, Daiichi Sankyo, Roche Diagnostics. F. Leclercq: None. P. Gueret: None. E. Bonnefoy-Cudraz: None. J. Ferrieres: Speakers Bureau; Modest; Amgen, AstraZeneca, MSD, Sanofi, Servier. Consultant/Advisory Board; Modest; Amgen, AstraZeneca, MSD, Sanofi, Servier. N. Danchin: Research Grant; Significant; AstraZeneca, Daiichi Sankyo, Eli-Lilly, GSK, MSD, Novartis, Sanofi. Speakers Bureau; Modest; Bayer, Boehringer Ingelheim, Eli Lilly, MSD, Novo Nordisk, Pfizer, Sanofi, Servier, The MedCo. Speakers Bureau; Significant; AstraZeneca. Consultant/Advisory Board; Modest; Amgen, AstraZeneca, Bayer, Eli-Lilly, GSK, MSD, Novo Nordisk, Roche, Sanofi. Consultant/Advisory Board; Significant; Servier.
- © 2014 by American Heart Association, Inc.