Background:
Most of the available literature on ST-Elevated myocardial infarction (STEMI)
in women was conducted in the developed world and data from Middle-East countries was limited.
Aims:
To examine the clinical presentation, patient management, quality of care, risk factors and inhospital
outcomes of women with acute STEMI compared with men using data from a large STEMI
registry from the Middle East.
Methods:
Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps),
a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern
countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations,
management and in-hospital outcomes were compared between the 2 groups.
Results:
Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia
compared with men who were more likely to be smokers (all p<0.001). Women had longer
median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED
to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI)
was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic
therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%,
p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days,
p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However,
after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital
mortality among women than men (6.4 vs. 4.6%), (p=0.145).
Conclusion:
Our study demonstrates that women in our region have almost double the mortality from
STEMI compared with men. Although this can partially be explained by older age and higher risk profiles
in women, however, correction of identified gaps in quality of care should be attempted to reduce
the high morbidity and mortality of STEMI in our women.
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