In-hospital mortality higher for young women after STEMI

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Young women with ST-elevation myocardial infarction spent more days in hospital, had higher rates of in-hospital mortality and were less likely to receive angioplasties and stenting than men, according to a study published in the Journal of the American College of Cardiology (JACC).

Whilst prior studies have shown that the rates of hospitalisation for heart attacks in patients under 60 have not changed over the past decade, there are few data tracking the trends in outcomes and methods for restoring blood flow in younger patients.

Researchers in this study used the Nationwide Inpatient Sample database to examine 632,930 STEMI patients between the ages of 18 and 59 from 2004 to 2011. Women were less likely to have presented with STEMI than men and were also less likely to have been treated to restore blood flow. However, overall trends in angioplasty and stenting increased in both men and women during the study period.

The study also showed that young women with STEMI died at a higher rate than young men, with 4.5% of women in the study dying in the hospital compared to 3%  of men. Women also had slightly longer hospital stays than men at 4.35 days versus four days on average.

Researchers speculated that men may be more likely than women to die before arriving at the hospital, which might in part explain the higher rate of in-hospital mortality for younger women.

Researchers said there could be several reasons for why younger women were less likely to receive revascularisation, including that they are less likely to have chest pain, which could lead to a delayed recognition of STEMI by their doctors. Women also have a two-fold higher risk of bleeding with procedures to restore blood flow compared to men, which could lead to some women not receiving guideline-specific interventional therapies.

“Despite guidelines directing use of stenting in heart attack patients, younger women are receiving this life-saving treatment method less than younger men,” said Deepak L. Bhatt, senior author of the study, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School in Boston. “Our research shows that there is a great opportunity and need to improve national heart attack care processes and outcomes and address these sex disparities in providing care to younger heart attack patients.”

American College of Cardiology/American Heart Association guidelines state that hospitals treating STEMI patients with emergency angioplasty/stenting should do so within 90 minutes or less of reaching the hospital. In response to challenges in meeting that time, the ACC launched the Door-to-Balloon (D2B) Alliance in 2006 with the goal of saving time and saving lives by reducing the time to which STEMI patients receive percutaneous coronary intervention in U.S. hospitals.