ObjectivesTo investigate the impact of gender in outcomes of patients with ST segment myocardial infarction in a setting with limited access to primary percutaneous coronary intervention MethodsIn 1017 consecutive patients hospitalized with ST segment myocardial infarction during years 2008–2013, distribution of risk factors, therapeutic methods, heart failure and in-hospital mortality were compared between males and females. Association of gender and primary outcomes was determined after adjustment for confounding factors. ResultsFemales were significantly older (66±12.1years vs. 59.5±12.7years, p<0.001). Prevalence of hypertension, hyperlipidemia and diabetes was significantly higher in females (72.2% vs. 39%, p<0.001, 36.1% vs. 20.3%, p<0.001, 46.5% vs. 32.1%, p<0.001, respectively). Presentation delay was similar in males and females. Females received reperfusion therapy more than males (63.2%vs. 55.8%, p=0.032). Development of heart failure and in-hospital mortality were significantly higher in females (36.5% vs. 27.2%, p=0.003 and 19.4% vs. 12.1%, p=0.002, respectively).However in multivariate analysis, female gender was not independently associated with increased rate of heart failure and in-hospital mortality ConclusionIn a center with low rate of primary percutaneous coronary intervention, crude rates of heart failure and in-hospital mortality are higher in females; however, the association is lost after adjustment for baseline characteristics