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. 2022 Jul 2;2(4):oeac042.
doi: 10.1093/ehjopen/oeac042. eCollection 2022 Jul.

Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries

Tora Hellgren  1 , Mai Blöndal  2 , Jarle Jortveit  3 , Tamas Ferenci  4 , Jonas Faxén  5 , Christian Lewinter  5 , Jaan Eha  2 , Piret Lõiveke  6 , Toomas Marandi  6 , Tiia Ainla  6 , Aet Saar  7 , Gudrun Veldre  6 , Péter Andréka  8 , Sigrun Halvorsen  9 , András Jánosi  8 , Robert Edfors  10
Affiliations

Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries

Tora Hellgren et al. Eur Heart J Open. .

Abstract

Aims: Data on how differences in risk factors, treatments, and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST-elevation myocardial infarction (STEMI) patients in different European countries.

Methods and results: Patients over the age of 18 with STEMI who were treated in hospitals in 2014-17 and registered in one of the national myocardial infarction registers in Estonia (n = 5817), Hungary (n = 30 787), Norway (n = 33 054), and Sweden (n = 49 533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic and cox regression models were used to study the associations of sex and outcomes in the respective countries. Women were older than men (70-78 and 62-68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment, and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality in-hospital rates (10.9-15.9 and 6.5-8.9%, respectively) at 30 days (13.0-19.9 and 8.2-10.9%, respectively) and at 1 year (20.3-28.1 and 12.4-17.2%, respectively) after hospitalization were higher in women than in men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for 1-year mortality.

Conclusion: Despite improved awareness of the sex-specific inequalities on managing patients with acute myocardial infarction in Europe, country-level data from this study show that women still receive less guideline-recommended management.

Keywords: Acute coronary syndrome; Acute myocardial infarction; Country comparisons; Equality; Real-world data; Sex.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
In-hospital, 30-day, and 1-year mortality rates stratified on sex in Estonia, Hungary, Norway, and Sweden.
See this image and copyright information in PMC

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