Age‐Related Sex Differences in Clinical Presentation, Management, and Outcomes in ST‐Segment–Elevation Myocardial Infarction: Pooled Analysis of 15 532 Patients From 7 Arabian Gulf Registries

Abstract

Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST‐segment–elevation myocardial infarction ( STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in‐hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI . A multiple variable regression model was used to assess sex differences in revascularization, in‐hospital mortality, and 1‐year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age‐stratified analysis showed that younger women (aged <65 years) with STEMI were more likely to seek acute medical care and were less likely to receive thrombolytic therapies or primary percutaneous coronary intervention and guideline‐recommended pharmacotherapy than men. Women had higher crude in‐hospital mortality than men, driven mainly by younger age (46–55 years, odds ratio: 2.60 [95% CI, 1.80–3.7]; P <0.001; 56–65 years, odds ratio: 2.32 [95% CI, 1.75–3.08]; P <0.001; and 66–75 years, odds ratio: 1.79 [95% CI, 1.33–2.41]; P <0.001). Younger women had higher adjusted in‐hospital and 1‐year mortality rates than younger men ( P <0.001). Conclusions Younger women (aged ≤65 years) with STEMI were less likely to receive guideline‐recommended pharmacotherapy and revascularization than younger men during hospitalization and had higher in‐hospital and 1‐year mortality rates.