ASSOCIATION OF GENDER WITH IN-HOSPITAL OUTCOMES OF ST-ELEVATION MYOCARDIAL INFARCTION

N SULTAN; A ASHRAF; I KHAN; AEJ NASIR; AK AFRIDI

doi:10.54112/pjicm.v5i02.158

Authors

N SULTAN Department of Cardiology, Khyber Teaching Hospital MTI Peshawar, Pakistan
A ASHRAF Department of Cardiology, Khyber Teaching Hospital MTI Peshawar, Pakistan
I KHAN Department of Cardiology, Khyber Teaching Hospital, MTI, Peshawar, Pakistan
AEJ NASIR Department of Cardiology, Khyber Teaching Hospital, MTI, Peshawar, Pakistan
AK AFRIDI Department of Cardiology, Khyber Teaching Hospital, MTI, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.158

Keywords:

ST-Elevation Myocardial Infarction, Gender, In-Hospital Outcomes, Heart Failure, Mitral Regurgitation

Abstract

Background: ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide. Gender-based differences in in-hospital outcomes following STEMI have been reported, but data from local populations are limited. Objective: To determine the frequency of in-hospital outcomes of STEMI and compare them between male and female patients. Study Design: Descriptive study. Setting: Department of Cardiology, Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 06-February-2025 to 06-June-2025. Methods: A total of 251 patients (aged 30–75 years) of either gender, diagnosed with STEMI confirmed by ECG and elevated cardiac troponin levels, were included in this study. In-hospital outcomes assessed were tricuspid regurgitation, mitral regurgitation, arrhythmia, and heart failure. Data were analysed using SPSS version 21; the chi-square test was applied to compare categorical variables, with p < 0.05 considered statistically significant. Results: The mean age of patients was 58.00 ± 13.23 years, with 133 (53.0%) males and 118 (47.0%) females. Overall in-hospital outcomes included tricuspid regurgitation (31.9%), mitral regurgitation (20.3%), arrhythmia (19.1%), and heart failure (12.0%). Heart failure was significantly more frequent in females compared to males (18.6% vs. 6.0%; p = 0.002), while mitral regurgitation was also more common among females (26.3% vs. 15.0%; p = 0.02). Conclusion: Tricuspid regurgitation was the most frequent in-hospital outcome of STEMI, followed by mitral regurgitation and arrhythmia. Heart failure and mitral regurgitation occurred significantly more often in females, highlighting the need for gender-specific management strategies in STEMI patients.

References

Bouisset F, Ruidavets JB, Dallongeville J, Moitry M, Montaye M, Biasch K, et al. Comparison of short- and long-term prognosis between ST-elevation and non-ST-elevation myocardial infarction. J Clin Med. 2021;10(2):180. https://doi.org/10.3390/jcm10020180

Zgheib H, Al Souky N, El Majzoub I, Wakil C, Sweidan K, Kaddoura R, et al. Comparison of outcomes in ST-elevation myocardial infarction according to age. Am J Emerg Med. 2020;38(3):485–90. https://doi.org/10.1016/j.ajem.2019.05.002

Chang SS, Lu CR, Chen KW, Kuo ZW, Yu SH, Lin SY, et al. Prognosis between ST-elevation and non-ST-elevation myocardial infarction in older adult patients. Front Cardiovasc Med. 2022;8:749072. https://doi.org/10.3389/fcvm.2021.749072

Norton JM, Reddy PK, Subedi K, Fabrizio CA, Wimmer NJ, Urrutia LE. Utilisation of an ICU severity of illness scoring system to triage patients with ST-elevation myocardial infarction. J Intensive Care Med. 2021;36(8):857–61. https://doi.org/10.1177/0885066620928263

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al.; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360. https://doi.org/10.1161/CIR.0000000000000350

Shah T, Haimi I, Yang Y, Gaston S, Taoutel R, Mehta S, et al. Meta-analysis of gender disparities in in-hospital care and outcomes in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2021;147:23–32. https://doi.org/10.1016/j.amjcard.2021.01.031

Hannan EL, Wu Y, Tamis-Holland J, Jacobs AK, Berger PB, Ling FS, et al. Sex differences in the treatment and outcomes of patients hospitalised with ST-elevation myocardial infarction. Catheter Cardiovasc Interv. 2020;95(2):196–204. https://doi.org/10.1002/ccd.28286

Hellgren T, Blöndal M, Jortveit J, Ferenci T, Faxén J, Lewinter C, et al. Sex-related differences in the management and outcomes of patients hospitalised with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries. Eur Heart J Open. 2022;2(4):oeac042. https://doi.org/10.1093/ehjopen/oeac042

Dreyer RP, Smolderen KG, Strait KM, Beltrame JF, Lichtman JH, Lorenze NP, et al. Gender differences in pre-event health status of young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardiovasc Care. 2016;5(1):43–54. https://doi.org/10.1177/2048872615568967

Alharbi MS, Alanazi BK, Alquhays IA, Alhamied NA, Al Shimemeri A. Effect of gender on the outcomes of ST-elevation myocardial infarction at a tertiary care hospital in Riyadh, Saudi Arabia. Cureus. 2020;12(8):e10118. https://doi.org/10.7759/cureus.10118

Ghaffari S, Pourafkari L, Tajlil A, Bahmani-Oskoui R, Nader ND. Is female gender associated with worse outcomes after ST-elevation myocardial infarction? Indian Heart J. 2017;69(Suppl 1):S28–33. https://doi.org/10.1016/j.ihj.2016.12.003

Patel I, Vyas P, Natarajan K, Kanabar K, Sharma V, Jain S, et al. The gender spectrum of in-hospital survival post primary percutaneous coronary intervention for ST-elevation myocardial infarction: exploring age-driven trends. J Saudi Heart Assoc. 2024;36(1):34–41. https://doi.org/10.37616/2212-5043.1372

Zahra K, Memon SMI, Jahanzeb, Salma, Bai S, Farooqui KS. Gender differences in clinical outcomes among STEMI patients undergoing primary PCI: a prospective study from a tertiary care hospital. J Popul Ther Clin Pharmacol. 2024;31(7):1652–8. https://doi.org/10.53555/jptcp.v31i7.7545

Birkemeyer R, Schneider H, Rillig A, Ebeling J, Akin I, Kische S, et al. Do gender differences in primary PCI mortality represent a different adherence to guideline-recommended therapy? A multicenter observation. BMC Cardiovasc Disord. 2014;14:71. https://doi.org/10.1186/1471-2261-14-71

Kytö V, Sipilä J, Rautava P. Gender and in-hospital mortality of ST-segment elevation myocardial infarction (from a multihospital nationwide registry study of 31,689 patients). Am J Cardiol. 2015;115(3):303–6. https://doi.org/10.1016/j.amjcard.2014.11.001

Phua AIH, Le TT, Tara SW, De Marvao A, Duan J, Toh DF, et al. Paradoxical higher myocardial wall stress and increased cardiac remodelling despite lower mass in females. J Am Heart Assoc. 2020;9(4):e014781. https://doi.org/10.1161/JAHA.119.014781