Abstract
Introduction
Women increased risk of early mortality following ST-segment elevation myocardial infarction (STEMI) has been attributed to older age, more comorbidities, and less primary revascularization (PCI). Data on long-term outcomes is conflicting, and younger patients' specific evidence is limited.
Purpose
Compare gender outcomes following STEMI within a cohort of younger (≤55 years) and older (>55 years) individuals.
Methods
Retrospective analysis of consecutive patients with STEMI who underwent PCI within 48 h of symptom onset, between 2010 and 2015. Adverse outcomes were defined as 30-day, 1-year and 5-year all-cause mortality, and 5-year MACE. Propensity score matching for age, CV risk factors, and prior CV disease aimed to establish a well-balanced subset of male and female individuals.
Results
Among 882 patients, 26.8 % were females. Women were older and had higher clinical severity. Although clinical and PCI success were similar, over a mean follow-up of 91 months, women demonstrated nearly three times the risk of 30-day mortality (10.4 % vs 3.7 %, HR 2.88; p ≤0.001) and double the risk of 5-year death (31.9 % vs 17.0 %, HR 2.07; p < 0.001) and MACE (39.0 % vs 17.6 %, HR 1.95; p < 0.001). Sex differences in the younger subgroup were seen for 1-year (HR 3.74, p < 0.001), and long-term outcomes: HR 2.20 (p = 0.05) for 5-year mortality; HR 2.10 (p = 0.027) for 5-year MACE. After propensity matching, sex remained an independent predictor of adverse outcomes.