Impact of the guidelines recommendations in the management of non-ST-segment elevation myocardial infarction according to gender. Analysis of 30-day mortality

Abstract

Abstract Funding Acknowledgements None. Background Current non-ST-segment elevation myocardial infarction (NSTEMI) guidelines recommend early invasive treatment (<24h) and simple antithrombotic treatment with aspirin (ASA). Classic studies describe a gender bias in the infarct treatment. Purpose To evaluate the impact of the guidelines recommendations in real-life management of NSTEMI in regards to invasive strategy and dual antiplatelet pretreatment (DAPT), and to analyze 30-day mortality according to gender. Methods A prospective unicentric registry of NSTEMI patients admitted to an Acute Cardiac Care Unit was conducted from January 2017 and December 2022. We analyzed the rates of early angiography (<24h) and pretreatment according to the guideline publication (01/09/2020). Patients were classified in two groups, depending on the time of admission in pre-guidelines (preCG) group (from January 2017 to September 1st 2020) and post-guidelines (postCG, admitted after September 1st 2020). We also analyzed the differences in management and 30-day mortality according to gender. Results A total of 787 consecutive NSTEMI patients were included, 24.9% women, mean age 65.3 years. Pretreatment with DAPT was routinely used in 90,2% of the cases, irrespective of gender or the new guidelines recommendation. Early angiography (<24 hours) was performed more frequently in men than women (61.6% vs 53.1%, p=0,035), although since the new guideline publication the early invasive management has increased in both genders (51.3% vs 72.6% in men, p<0,001; and 43.3% vs 64.1% in women, p=0,003). 30-day mortality tends to be higher in men, although the difference was not significant (4.6% in men vs 2.6% in women, p=0,212) and was not affected by the guideline publication (preCG 4.6% vs postCG 4.6% in men, p=0,994, preCG 2.9% vs post CG 2.2% in women, p=0,752). Conclusions In our NSTEMI registry there was an increase in the rates of early angiography, both in men and women, since the guideline publication, but there’s still a gender bias in the invasive treatment. Most NSTEMI patients still received DAPT pretreatment, without differences after the guideline publication. Despite the increase in early invasive management, 30-day mortality rates remain unchanged in both groups.