Despite continued improvement in ST elevation myocardial infarction (STEMI) outcomes, gender disparities remain [ ]. The higher STEMI related mortality seen in women has been blamed on an older age at presentation and presence of comorbidities. Women with STEMI present 5 to 10 years later than their male counterparts and consequently have accrued more “traditional cardiovascular risk,” and the differences in mortality between men and women with STEMI have long been considered to be age dependent [ ]. However, these differences do not completely explain the gap in outcome between the genders in STEMI population, and the difference persists after adjustment for these variables. This gender gap is even more evident in younger females. Several other factors have been hypothesized to be contributory, including longer delays to definitive reperfusion, mostly due to atypical symptoms, as well as system-related delays. Women presenting with STEMI who undergo intervention also have a higher rate of periprocedural complications. The pathophysiology of STEMI in women has been found to be more commonly due to plaque erosions rather that plaque rupture, which is seen more commonly in male patients [ ]. Studies have found that women presenting with STEMI have longer patient delays, prehospital healthcare delays, hospital delays, and total healthcare delays compared with male patients, and these time delays persist after adjustment for confounders. It has also been found that two thirds of the total delays in STEMI care in women result from healthcare delays [ ]. Women are less likely to undergo advanced therapies such as mechanical circulatory support in case of shock in the setting of STEMI than men [ ]. Myocardial infarction with nonobstructive coronary arteries (MINOCA), takotsubo cardiomyopathy, spontaneous coronary artery dissection (SCAD), and coronary vasospasm are more commonly seen in women [ , ]. Management of these conditions is less well-defined and arbitrary and, therefore, less likely to meet the standards of care.
Cardiovascular Revascularization Medicine, 2021-10-01, Volume 31, Pages 48-49
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