Clinical characteristics and in-hospital evolution of women with acute myocardial infarction in the SAC-FAC National Registry of Infarction

Abstract

Introduction: Despite advances in the treatment of infarction, the prognosis remains related to classic factors such as age, heart failure, ventricular function and sex. Previous studies showed higher mortality in women, attributed to differences in age, comorbidities and access to therapies. Objective: To compare clinical characteristics and hospital prognosis according to gender in patients with acute myocardial infarction with ST elevation (STEMI). Material and methods: A prospective, observational, multicenter study in the Argentine Republic carried out in 247 centers (all provinces and the city of Buenos Aires) including a total of
1759 pts, with a diagnosis of STEMI of up to 36 hours of evolution, performed from March to December 2015. Of these, 394 (22.39%) were women. Results: The median age of the women was higher (66 vs 59.7 years, p <0.001). The prevalence of coronary risk factors was different; less smoking was observed (25% vs 46.7%, p <0.001), more diabetes (29.8 v 24.9%, p=0.018), and HTN (70.7% vs 55.7%, p <0.001). Women had less coronary heart disease (10.1% vs 14.5%, p=0.016) and previous PTCA (7.5% vs 10.6%, p=0.04). The pain-admission time was greater in women (150 vs 120 min, p=0.03). The reperfusion rate was similar with a slight tendency to lower use of fibrinolytics. Hospital mortality was higher in women (11.2% vs 8.1%, p=0.04), with a similar rate of re-infarction (2 vs 1.6%, p = 0.35), post-infarction angina (3 vs 2.3%, p=0.43) and cardiogenic shock (23.7 vs 21%, p=0.26), HF (14.2 vs 11.4, p=0.07). However, in the multiple logistic regression model, gender was not an independent predictor of higher mortality. Associated variables were age (HR=1.087, 95% CI 1.037-1.139, p=0.006), blood pressure at admission (HR = 0.98, CI 95% 0.966-0.999, p=0.043) and the presence of heart failure (HR = 9.280, CI 95% 2.441-35.281, p=0.004).
Conclusions: Women admitted for STEMI have a different risk profile than men, receive fewer therapies recommended by the guidelines, but with similar use of invasive strategy. Although hospital mortality was higher, sex was not an independent predictor of risk.