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Lower intervention rates after STEMI in women than in men

By Bianca Nogrady
Gender differences in cardiovascular (CV) care persist in Australia, say the authors of a study that shows significantly lower revascularisation and cardiac rehabilitation rates in women than in men after a myocardial infarction (MI).

Writing in the Medical Journal of Australia, the authors report the results of a retrospective cohort study involving 2898 patients (2183 men and 715 women) with an ST-elevation myocardial infarction (STEMI), across 41 Australian hospitals between February 2009 and May 2016.

They found women had 47% lower odds (odds ratio, 0.53) of undergoing coronary angiography, 58% lower odds of total revascularisation or coronary artery bypass graft and 24% lower odds of primary percutaneous coronary intervention than men.

On discharge, women had 25% lower odds of being referred for cardiac rehabilitation, 49% lower odds of being prescribed statins and 22% lower odds of receiving beta blockers. Six months after admission, women had 2.68-fold higher odds of major adverse CV events and 2.17-fold higher odds of mortality.

The differences in care and outcomes between men and women persisted at every level of disease severity and risk, as measured by patients’ Global Registry of Acute Coronary Event (GRACE) score.

Lead author Professor Clara Chow, Professor of Medicine at The University of Sydney, said the findings served as a reminder than that clinicians should consciously consider potential barriers in managing MI in women, but the causes of the sex differences were still unclear.

‘However, we do know that it is much less likely that the differences in this study are a function of presentation or physiology as the patients all had the same type of MI – STEMI,’ said Professor Chow, Academic Director of the Westmead Applied Research Centre, Sydney.

Professor Chow told Cardiology Today that women were more likely to have non-obstructive coronary disease and to present with atypical symptoms. However, she noted that CV clinical trials also tended to recruit fewer women, so there was less research to guide management of women or explore sex differences in treatment outcomes.

‘Women who have a STEMI type of heart attack are at higher risk of mortality than men and every care should be taken to ensure they are treated intensively to prevent subsequent CV events,’ she said.
Med J Aust 2018; doi: 10.5694/mja17.01109.