Abstract Body (Do not enter title and authors here): Background
Over the past decade, research has focused on gender disparities in cardiovascular outcomes. Historically, women have had higher mortality rates and worse outcomes after STEMI compared to men. This study aims to investigate if advancements in interventional cardiology and pre-hospital and in-hospital care have improved outcomes for women over 10 years.
Methods
PubMed, Scopus and Cochrane were reviewed for cohort studies and registries from 2014-2024 comparing male and female STEMI patients, focusing on mortality, reinfarction, heart failure, stroke, and stent thrombosis. In-hospital and 1-year outcomes were assessed. Statistical analysis used Review Manager and I^2 for heterogeneity with a random-effects model.
Results
We found 28 studies from 39 countries, with 39% female participants. T2DM was prevalent for 33.2% of males and 36.9% of females, with 32.2% of males and 21.3% of females being smokers. Both genders had an equal history (50%) of previous MI, PCI, and CABG. Primary PCI was performed in a majority (73%) of male patients compared to 62% of female patients; while thrombolysis was received by 73.1% of males and 61.5% of females.
For in-hospital outcomes, women have a higher all-cause mortality risk (RR = 1.77, 95% CI: 1.65-1.91), consistent in 2014-2018 (RR = 1.75, 95% CI: 1.49-2.05) and 2019-2024 (RR = 1.79, 95% CI: 1.63-1.96; P = 0.81) Women have higher risks of stroke (RR = 1.64, 95% CI: 1.34-2.02) and heart failure (RR = 1.50, 95% CI: 1.31-1.70) No significant differences were found in reinfarction (RR = 1.19, 95% CI: 0.82-1.74) or stent thrombosis (RR = 1.05, 95% CI: 0.53-2.07)
At 1 year, women have a significantly higher all-cause mortality risk (RR = 1.94, 95% CI: 1.48-2.53), observed in both 2014-2018 (RR = 1.77, 95% CI: 1.26-2.50) and 2019-2024 (RR = 1.98, 95% CI: 1.45-2.72; P = 0.64) Women also face higher cardiovascular mortality (RR = 2.45, 95% CI: 1.11-5.40) and stroke risk, (RR = 1.85, 95% CI: 1.43-2.39) with no significant difference in reinfarction risk (RR = 0.96, 95% CI: 0.53-1.73)
Conclusion
Women with STEMI still face higher risks of in-hospital and 1-year all-cause mortality, stroke, and heart failure compared to men, indicating insufficient improvement in outcomes. There were no significant differences in reinfarction and stent thrombosis. It is important for future efforts to focus on understanding these disparities to improve outcomes for women.