Sex based disparities in stemi outcomes: higher in-hospital mortality in women from a national registry of 10,229 patients

Abstract Background ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. While prior research has suggested sex-based disparities in STEMI outcomes, large-scale contemporary data on haemodynamic presentation and mortality differences remain limited. This study investigates sex differences in mortality and clinical presentation among 10,229 STEMI patients using data from the Irish Heart Attack Audit (IHAA) over a seven-year period (2017–2023). Methods We conducted a retrospective analysis of STEMI patients recorded in the IHAA between January 2017 and December 2023. Clinical and demographic data were extracted, including patient age, sex, comorbidities, haemodynamic status at presentation, and in-hospital mortality. The primary outcomes were cardiogenic shock at presentation and in-hospital mortality. We used both unadjusted and adjusted logistic regression models to assess the association between sex and these outcomes. We adjusted for key risk factors including age, diabetes mellitus (DM), chronic kidney disease (CKD) and time from symptom onset to first medical contact (FMC). An interaction term between age and female sex was included in the adjusted model to evaluate whether the relationship between sex and the outcomes varied with age. Results Among the cohort of 10,229 patients, women accounted for 22.4% of cases. (Table 1) Compared to men, women had significantly higher odds of presenting in cardiogenic shock in crude analysis (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.03 to 1.61; p = 0.028), though this association was borderline in adjusted analysis (adjusted OR: 4.60, 95% confidence interval [CI]: 0.98 to 21.53; p = 0.053). Women had significantly higher crude in-hospital mortality rates (OR: 1.52, 95% CI: 1.27 to 1.83; p<0.001), with this association remaining significant and potentially amplified after adjustment (adjusted OR: 5.10, 95% CI: 1.20 to 21.67; p = 0.027). Age, CKD and time from symptom onset to FMC were significantly associated with shock and mortality in adjusted models. Diabetes was significantly associated with mortality but not with shock. The interaction term between female sex and age was significant, suggesting the relationship varies by age, with younger women having higher odds of mortality compared to younger men, though this difference diminishes with age. Conclusion In this large, national cohort of STEMI patients from the IHAA (2017–2023), women had significantly higher odds of in-hospital mortality and a possible increased risk of presenting with cardiogenic shock after adjusting for key clinical factors including age. These disparities underscore the need to investigate biological, clinical, and systemic factors influencing STEMI outcomes in women. Future studies should explore sex-specific pathophysiological mechanisms and disparities in STEMI recognition and management to improve outcomes.