Timely reperfusion with primary percutaneous coronary intervention (pPCI) in patients with ST-elevation myocardial infarction (STEMI) must be the standard of care, irrespective of gender. Current guidelines mandate a door-to-balloon time of less than 90 minutes from STEMI diagnosis to wire crossing. However, coronary artery disease is characterized by relevant gender differences in terms of anatomy, pathophysiology, and clinical presentation. Female’s symptoms could be deceitful, and diagnosis could be delayed. Aim of our study was to evaluate the presence of gender differences at our Centre in diagnosing and treating STEMI.
We retrospectively analyzed a cohort of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit of ASST Great Metropolitan Hospital Niguarda (Milan) between January 2014 and July 2022. Clinical parameters were collected and waiting times from symptoms onset and ECG recording to pPCI were compared between sexes.
489 STEMI patients were included in our study, 384 men and 105 women. Median age was higher in women (75 years vs 61 years, p < 0.05) as was the incidence of arterial hypertension (70% vs 52.9%, p < 0.05). Women smoked less frequently than men (20.9% vs 39.1%, p < 0.05). Median waiting times from symptoms onset to balloon and from ECG recording to balloon were higher in females (320 vs 240 min, p < 0.05 and 111 vs 80 min, p < 0.05). After stratifying patients by age, chest pain to balloon times were higher in women aged > 65 compared to men in the same age category (320 min vs 292 min, p < 0.05). Regarding younger patients, ECG to balloon and chest pain to balloon times were always longer in females but without reaching statistical significance. A trend towards increased in-hospital mortality was noticed in females (7.6% vs 3.3%, p = 0.05).
Our study suggests that a gender gap may exist in diagnosing STEMI, with longer times from symptoms onset to balloon and from ECG recording to balloon in female patients. This may lead to increased in-hospital mortality in women.