Coronary revascularization and sex differences in cardiovascular mortality after myocardial infarction in 12 high and middle-income European countries
Cenko, Edina (Università di Bologna)
Yoon, J. (Google Cloud AI)
Bergami, Maria (Università di Bologna)
Gale, C.P. (University of Leeds)
Vasiljevic, Z. (University of Belgrade)
Vavlukis, Marija (Cyril and Methodius University in Skopje)
Kedev, Sasko (Cyril and Methodius University in Skopje)
Miličić, D. (University Hospital Center Zagreb)
Dorobantu, M. (University of Medicine and Pharmacy "Carol Davila")
Badimon, Lina (Institut de Recerca Sant Pau)
Manfrini, Olivia (IRCCS Azienda Ospedaliero-Universitaria di Bologna Sant'Orsola Hospital)
Bugiardini, Raffaele (Università di Bologna)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2025
Resum:	Background Existing data on female sex and excess cardiovascular mortality after myocardial infarction (MI) mostly come from high-income countries (HICs). This study aimed to investigate how sex disparities in treatments and outcomes vary across countries with different income levels. Methods Data from the ISACS Archives registry included 22 087 MI patients from 6 HICs and 6 middle-income countries (MICs). MI data were disaggregated by clinical presentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). The primary outcome was 30-day mortality. Results Among STEMI patients, women in MICs had nearly double the 30-day mortality rate of men [12. 4% vs. 5. 8%; adjusted risk ratio (RR) 2. 30, 95% CI 1. 98-2. 68]. This difference was less pronounced in HICs (6. 8% vs. 5. 1%; RR 1. 36, 95% CI 1. 05-1. 75). Despite more frequent treatments and timely revascularization in MICs, sex-based mortality differences persisted even after revascularization (8. 0% vs. 4. 1%; RR 2. 05, 95% CI, 1. 68-2. 50 in MICs and 5. 6% vs. 2. 6%; RR 2. 17, 95% CI, 1. 48-3. 18) in HICs. Additionally, women from MICs had higher diabetes rates compared to HICs (31. 8% vs. 25. 1%, standardized difference = 0. 15). NSTEMI outcomes were relatively similar between sexes and income groups. Conclusions Sex disparities in mortality rates following STEMI are more pronounced in MICs compared to HICs. These disparities cannot be solely attributed to sex-related inequities in revascularization. Variations in mortality may also be influenced by sex differences in socioeconomic factors and baseline comorbidities.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Middle-income countries ; Myocardial infarction ; Outcomes ; Sex differences
Publicat a:	European Heart Journal - Quality of Care and Clinical Outcomes, Vol. 11, Num. 6 (January 2025) , p. 719-729, ISSN 2058-1742

DOI: 10.1093/ehjqcco/qcae035
PMID: 38714331

11 p, 1.1 MB

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