Closing the sex gap in time delays and mortality in ST-segment elevation myocardial infarction: insights from the National Registry of Invasive Cardiology Procedures (ORPKI).

INTRODUCTION

Despite improvements in cardiovascular care, sex disparities persist in the outcomes of patients presenting with ST‑segment elevation myocardial infarction (STEMI).

OBJECTIVES

This study aimed to investigate the change in sex‑based differences in treatment delays, procedural complications, and outcomes among patients admitted for STEMI over the years.

PATIENTS AND METHODS

Data from the National Registry of Invasive Cardiology Procedures recorded between 2014 and 2022 were retrospectively analyzed, focusing on patients without cardiogenic shock who underwent primary percutaneous coronary intervention (PCI).

RESULTS

Women comprised 32% of a total of 123 829 STEMI patients. Treatment delays from chest pain onset to the first medical contact and PCI were longer in women (239 vs 216 min; P <0.001 and 123 vs 114 min; P <0.001, respectively). Women were less likely to be treated with stents (86.8% vs 89%; P <0.001). Periprocedural complications, including cardiac arrest (1.5% vs 1.3%; P = 0.03), perforation (0.3% vs 0.2%; P = 0.03), no‑reflow (1.6% vs 1.3%; P = 0.002), and mortality in a catheterization laboratory (0.8% vs 0.6%; P <0.001), were higher in women. Over time, we have noted a reduction of this mortality gap between men and women since 2014, and an absolute decrease in deaths in the catheterization laboratory for women.

CONCLUSIONS

This study shows significant sex‑based disparities in STEMI care. Women experience longer treatment delays, receive less aggressive revascularization, and have worse periprocedural outcomes than men. However, the gap is gradually closing, which may reflect recent underscoring the need for sex‑specific approaches in STEMI management.