Clinical Profiles, Outcomes, and Sex Differences of Patients With STEMI
Arman Qamar, Kirtipal Bhatia, Sameer Arora, Michael Hendrickson, Puneet Gupta, Amber Fatima, Girish MP, Ankit Bansal, Vishal Batra, Mark J. Ricciardi, Cindy L. Grines, Jamal Yusuf, Saibal Mukhopadhyay, Sidney C. Smith, Sanjay Tyagi, Deepak L. Bhatt, Martha Gulati, Mohit Gupta
Abstract
Low- and middle-income countries account for most of the global burden of coronary artery disease. There is a paucity of data regarding epidemiology and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in these regions. The authors studied the contemporary characteristics, practice patterns, outcomes, and sex differences in patients with STEMI in India. The North India ST-Elevation Myocardial Infarction registry is an investigator-initiated prospective cohort study of patients presenting with STEMI at tertiary medical centers in North India. Of 3635 participants, 16% were female patients, one-third were less than 50 years of age, 53% had a history of smoking, 29% hypertension, and 24% diabetes. The median time from symptom onset to coronary angiography was 71 hours; the majority (93%) presented first to a non-percutaneous coronary intervention (PCI)-capable facility. Almost all received aspirin, statin, P2Y12 inhibitors, and heparin on presentation; 66% were treated with PCI (98% femoral access) and 13% received fibrinolytics. The left ventricular ejection fraction was <40% in 46% of patients. The 30-day and 1-year mortality rates were 9% and 11%, respectively. Compared with male patients, female patients were less likely to receive PCI (62% vs 73%; P < 0.0001) and had a more than 2-fold greater 1-year mortality (22% vs 9%; adjusted HR: 2.1; 95% CI: 1.7-2.7; P < 0.001). In this contemporary registry of patients with STEMI in India, female patients were less likely to receive PCI after STEMI and had a higher 1-year mortality compared with male patients. These findings have important public health implications, and further efforts are required to reduce these gaps.