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Hospitalized Young Women Less Likely to Get Optimal STEMI Interventions

BOSTON – Are young women with ST-elevation myocardial infarction (STEMI) victims of sex discrimination in hospitals or is something else going on?

That is the question raised by a new study in the Journal of the American College of Cardiology, which finds that younger women were less likely to receive life-saving angioplasty and stenting to restore blood flow to blocked arteries than men. In addition, reports the study team led by researchers from Brigham and Women's Hospital and Harvard Medical School, those female patients had longer hospital stays and higher rates of in-hospital mortality.

According to background information in the article, the recommended treatment for STEMI, the deadliest type of heart attack caused by a prolonged blockage of blood supply in the heart, is immediate stenting to restore blood flow. Previous research has found that older women presenting with STEMI also are less likely to receive revascularization and have worse outcomes relative to their male counterparts.

For this study, researchers used the Nationwide Inpatient Sample database to examine 632,930 STEMI patients between the ages of 18 and 59 from 2004-11. Results indicate that women with acute myocardial infarction were less likely to have presented with STEMI than men – odds ratio (OR) 0.74. They also were less likely than men to receive percutaneous coronary intervention, OR 0.74; coronary artery bypass grafting, OR 0.61 or thrombolysis, OR 0.80.

On the other hand, overall trends in angioplasty and stenting increased in both men and women during the study period.

The death rate for hospitalized young women with STEMI was 4.5%, compared to 3% of men. Length-of-stay also was slightly longer for women than men – 4.35 days vs. 4 days on average.

One reason for the difference in LOS, according to the researchers, is that men might have been more likely than women to die before arriving at the hospital, which also might help explain the higher rate of in-hospital mortality for younger women.

Other reasons for the disparity in revascularization use, study authors suggest, is that younger women were less likely to have chest pain, which could lead to a delayed recognition of STEMI. Females also have twice the risk of bleeding with procedures to restore blood flow, compared to men, and that could have led to some women not receiving guideline-specific interventional therapies, they write.

"Despite guidelines directing use of stenting in heart attack patients, younger women are receiving this life-saving treatment method less than younger men," senior author Deepak L. Bhatt, MD, MPH, explained. "Our research shows that there is a great opportunity and need to improve national heart attack care processes and outcomes and address these sex disparities in providing care to younger heart attack patients."