882 Sex Differences in Outcomes of Patients Suffering From ST-Elevation Myocardial Infarction While Already in Hospital

Abstract

Two cohorts face high mortality after ST-elevation myocardial infarction (STEMI): women and patients with STEMI that occur whilst already admitted to hospital, termed “in-hospital STEMI”. However, sex differences in outcomes of in-hospital STEMIs are unknown. From 2013-2018, consecutive patients presenting with STEMI treated with percutaneous coronary intervention (PCI) were prospectively recruited into the Victorian Cardiac Outcomes Registry. Female patients with in-hospital STEMI were compared to male in-hospital STEMI with a primary endpoint of 30-day major adverse cardiovascular events (MACE). Secondary endpoints included total mortality, symptom-to-device (STD) time, major adverse cardiovascular and cerebrovascular events (MACCE) and major bleeding. Adjustment was made for age, comorbidities, left ventricular function, cardiac arrest and cardiogenic shock. 7,493 patients underwent PCI for STEMI with 494 (6.6%) in-hospital STEMI of which 158/494 (31.9%) were women. Female patients with in-hospital STEMI were significantly older (69.5 versus 65.9 years, p=0.003) than men, with no differences in baseline comorbidities. Female in-hospital STEMI had significantly longer adjusted geometric mean STD time than men (104.6 versus 94.3 minutes, p<0.001). There were no sex differences in 30-day MACE, mortality, MACCE or major bleeding, with overall rates of 22.8%, 12.7%, 24.1% and 5.7% respectively. Female sex did not independently predict 30-day MACE. Patients with in-hospital STEMI suffer high MACE and mortality at 30 days. Women experience a mean 10-minute delay from symptom onset to reperfusion compared to men. However, even after adjustment for confounders, there were no sex differences observed in clinical outcomes.