Gender differences in the revascularization rates and in-hospital outcomes in hospitalizations with ST segment elevation myocardial infarction.

Background: Gender differences have been noted in patients presenting with ST segment elevated myocardial infarction (STEMI) but the reason remained poorly defined. We hypothesize that women presenting with STEMI are associated with poor reperfusion strategies which leads to worse in-hospital outcomes. Our goal is to identify age-stratified gender differences in revascularizations and in-hospital outcomes in patients presented with STEMI.

Methods: We used the 2012 to 2015 Nation Inpatient Sample databases to identify all patients ≥ 18 years of age hospitalized with STEMI. Resource utilization including revascularization strategies and in-hospital outcomes were compared in propensity-matched women and men in the overall cohort as well as two major age groups (< 65 years and ≥ 65 years).

Results: Less women presented with STEMI (32.3%). After propensity matching, women were less likely to receive revascularization compared to men. These disparities were seen in both age groups. The in-hospital mortality in the overall cohort was significantly higher in women (10.6% vs 8.9%, P < 0.001). In-hospital mortality was higher in women in both age groups (5.8% vs 4.4% and 14% vs 12.2% in groups 1 and 2, respectively, P < 0.001 for both). The length of stay was higher in women in both age groups compared to men (group 1-4.6 vs 4.3 days, P < 0.001; group 2-5.4 vs 5.3 days, P < 0.01).

Conclusions: Regardless of age, women presenting with STEMI are less likely to receive revascularization and have higher in-hospital mortality, longer length of stay, and more likely to be discharged to other acute care facility.