Younger women lose out on revascularisation

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Younger women may be less likely to receive re-vascularisation for ST-segment elevation myocardial infarction (STEMI) and may have higher in-hospital mortality compared with younger men, according to a new study.

The study analysed 632,930 STEMI patients between the ages of 18 and 59 in the Nationwide Inpatient Sample database between 2004 and 2011. Overall, younger women were less likely than men to present with STEMI, and younger women were less likely to receive re-perfusion for STEMI as compared to their younger male counterparts. However, use of percutaneous coronary intervention for STEMI and in-hospital mortality increased in both men and women during the study period.

The study also showed that young women with STEMI died at a higher rate than young men, with 4.5% of women in the study dying in the hospital compared to 3% of men. Women also had slightly longer hospital stays than men at 4.35 days versus four days on average. Researchers speculated that men may be more likely than women to die before arriving at the hospital, which might in part explain the higher rate of in-hospital mortality for younger women.

“Despite guidelines directing use of stenting in heart attack patients, younger women are receiving this life-saving treatment method less than younger men,” says Dr Deepak L Bhatt, senior author of the study. “Our research shows that there is a great opportunity and need to improve national heart attack care processes and outcomes and address these sex disparities in providing care to younger heart attack patients.”

In a corresponding editorial comment, Drs Rashmee U. Shah and C Noel Bairey Merz, comment on the “methodological challenges unique to open-source data and analyses.” They conclude that moving forward, “We need an ecosystem of researchers with specific expertise to standardise and validate methods and uses of crowd-sourced data to speed the pace of medical research and maximise the potential of these growing resources.”

Abstract
Background: Older women presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to receive revascularization and have worse outcomes relative to their male counterparts.
Objectives: This study sought to determine temporal trends and sex differences in revascularization and in-hospital outcomes of younger patients with STEMI.
Methods: We used the 2004 to 2011 Nationwide Inpatient Sample databases to identify all patients age 18 to 59 years hospitalized with STEMI. Temporal trends and sex differences in revascularization strategies, in-hospital mortality, and length of stay were analyzed.
Results: From 2004 to 2011, of 1,363,492 younger adults (age Conclusions: Younger women are less likely to receive revascularization for STEMI and have higher in-hospital mortality as compared with younger men. Use of percutaneous coronary intervention for STEMI and in-hospital mortality have increased, whereas length of stay has decreased in both sexes over the past several years.

American College of Cardiology material
Journal of the American College of Cardiology abstract
Journal of the American College of Cardiology editorial


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