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Meta-Analysis
. 2025 Jul 17;15(7):e096334.
doi: 10.1136/bmjopen-2024-096334.

Long-term clinical impact of sex disparities in patients with ST elevation acute myocardial infarction: a systematic review and meta-analysis of adjusted observational studies

Gianluca Di Pietro  1 , Riccardo Improta  1 , Ovidio De Filippo  2 , Lucia Ilaria Birtolo  1 , Emanuele Bruno  1 , Gennaro Sardella  1 , Carmine Dario Vizza  1 , Fabrizio D'Ascenzo  2 , Giulio Stefanini  3 , Massimo Mancone  4
Affiliations
Meta-Analysis

Long-term clinical impact of sex disparities in patients with ST elevation acute myocardial infarction: a systematic review and meta-analysis of adjusted observational studies

Gianluca Di Pietro et al. BMJ Open. .

Abstract

Objectives: We aimed to address an evidence gap by investigating the clinical impact of sex differences on long-term outcomes after primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction.

Design: Systematic review and meta-analysis.

Data sources: Medline, Scopus and EMBASE were searched through August 2024.

Eligibility criteria for selecting studies: We included adjusted observational studies reporting HRs, comparing long-term clinical outcomes (beyond 1 year) between women and men undergoing pPCI for ST-elevation myocardial infarction.

Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias using the ROBINS I (Risk Of Bias In Non-randomised Studies - of Interventions) tool. Data were pooled using generic inverse-variance weighting, computing risk estimates with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic).

Results: 22 observational studies globally encompassing 358 140 patients (169 659 women vs 188 490 men) were included in the quantitative analysis. After a median follow-up of 3.3 years, no significant differences in terms of all-cause mortality were reported after multivariable adjustments (adjusted HR, adjHR 1.06, 95% CI 0.99 to 1.14, p=0.10). Women had a higher rate of cardiac death compared with men after multivariable adjustments (adjHR 1.86, 95% CI 1.25 to 2.77, p=0.002). No other significant differences in terms of recurrent MI, stent thrombosis and target vessel revascularisation persisted between women and men after multivariable adjustments.

Conclusions: Women undergoing pPCI for acute ST-elevation myocardial infarction experience an increased risk of cardiac death compared with men after a long-term follow-up.

Prospero registration number: CRD42024580932.

Keywords: CARDIOLOGY; Coronary heart disease; Sexual and Gender Minorities.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. PRISMA flow chart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; NSTE-ACS, Non- ST elevation- Acute Coronary Syndrome.
Figure 2
Figure 2. Age-adjusted results for all-cause death, primary analysis (A) and sensitivity analysis (B). IV, inverse variance.
Figure 3
Figure 3. Multivariable adjusted results for all-cause of death, primary analysis (A) and sensitivity analysis (B). Abbreviations as in figure 1. IV, inverse variance.
Figure 4
Figure 4. Age-adjusted results for cardiac death (A). Multivariable-adjusted results for cardiac death, primary (B) and sensitivity analysis (C). Abbreviations as in figure 1. IV, inverse variance.
Figure 5
Figure 5. Age-adjusted and multivariable-adjusted results for recurrent myocardial infarction. Abbreviations as in figure 1. IV, inverse variance.
See this image and copyright information in PMC

References

    1. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13–20. doi: 10.1016/S0140-6736(03)12113-7. - DOI - PubMed
    1. Mehta LS, Beckie TM, DeVon HA, et al. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation. 2016;133:916–47. doi: 10.1161/CIR.0000000000000351. - DOI - PubMed
    1. D’Ascenzo F, Gonella A, Quadri G, et al. Comparison of mortality rates in women versus men presenting with ST-segment elevation myocardial infarction. Am J Cardiol. 2011;107:651–4. doi: 10.1016/j.amjcard.2010.10.038. - DOI - PubMed
    1. Thomas JL, Braus PA. Coronary artery disease in women. A historical perspective. Arch Intern Med. 1998;158:333–7. doi: 10.1001/archinte.158.4.333. - DOI - PubMed
    1. Pancholy SB, Shantha GPS, Patel T, et al. Sex Differences in Short-term and Long-term All-Cause Mortality Among Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Intervention. JAMA Intern Med . 2014;174:1822. doi: 10.1001/jamainternmed.2014.4762. - DOI - PubMed

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