Disadvantage diminishes with older age, however Women continue to be at higher risk of 30-day mortality after ST-segment elevation MI (STEMI) even in the current era of percutaneous coronary intervention (PCI), according to researchers. In the 30 days after stenting, 11.6% of women versus 6.0% of men died, a difference found to be statistically significant even after adjusting for baseline characteristics, medications, and use of primary PCI (adjusted OR 1.29, 95% CI 1.01-1.65), according to Raffaele Bugiardini, MD, of Italy's University of Bologna, and colleagues. However, the excess mortality among women was only significant at younger ages, Bugiardini's group reported online in JAMA Internal Medicine: Under 60 years: 4.7% for women versus 3.0% for men (adjusted OR 1.88, 95% CI 1.04-3.26) 60-74 years: 9.2% versus 6.4% (adjusted OR 1.28, 95% CI 0.88-1.88) 75 years and older: 20.9% versus 17.9% (adjusted OR 1.17, 95% CI 0.80-1.73) "Indeed, women are less likely to receive aspirin, β-blockers, and reperfusion therapies at admission. Thus, the extent to which mortality rate differences between men and women are related to disparities in treatment or dissimilarities in pathophysiology remain a matter of debate," according to the investigators. Women were also less likely than men to present within 2 hours of symptom onset, Bugiardini and colleagues noted, though the odds were better the younger these women were. Data for the study came from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry. The analysis included recipients of contemporary PCI in 2010-2016 across Eastern and Western Europe (n=8,834). The cohort's mean age was 59.9 years, and 30% were women. Stroke and minor bleeding rates trended higher for women without reaching statistical significance. However, women's 30-day major bleeding risk did turn out higher than for men (1.9% versus 1.1%, P=0.046). Moreover, as observed in the general ISACS-TC population, female STEMI patients had a higher risk of short-term mortality among those getting primary PCI (7.1% versus 3.3% for male peers, P<0.001). Source
