Delayed Presentation and Poor Outcomes for Women in an Australian STEMI Cohort

Abstract

Background: Cardiovascular disease is a leading cause of mortality in Australian woman. Gender based differences are known to exist in treatment and outcomes of ischaemic heart disease. Methods: We conducted an observational cohort study using prospectively collected registry data to examine whether gender based differences exist in the presentation, treatment, and clinical outcomes of patients with ST-elevation myocardial infarction (STEMI). The study involved 3,665 patients who presented to 12 hospitals between 2004–2018. Outcome measures included time to reperfusion, major complications (death, MI, CVA) and mortality with follow-up to 24 months. Results: Women (n = 755, 20.6%) were older (65 vs 59yr, p < 0.001) and more likely to have hypertension (60.4% vs 51.5%, p < 0.001) and diabetes (33.6 vs 28.6%, p = 0.021). Women had longer overall reperfusion times (S2RT 235 vs 215min, p = 0.002), which were driven by pre-hospital delays (S2DT 107 vs 95min, p = 0.001). In-hospital treatment times did not differ substantially. Women had lower rates of multi-vessel disease (49 vs 53.2%, p < 0.001) but were less likely to undergo stenting (86.7 vs 92.7%, p < 0.001). Post discharge, women had lower rates of referral to cardiac rehabilitation (73.3 vs 82.7%, p = 0.002) and experienced higher rates of complications and death (24mth major comp: 28 vs 17%, death 27 vs 15%; p < 0.001). Conclusion: Women presenting with STEMI are older, have prolonged reperfusion times and have lower rates of cardiac stenting. Following discharge, women experience nearly twice the rates of major complications and death post STEMI. Factors contributing to these disparities require further investigation.