Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Ziwei Xi; Hong Qiu; Tingting Guo; Yong Wang; Jianan Li; Yang Li; Jianfeng Zheng; R Gao

doi:10.1136/bmjopen-2021-053379

Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

BMJ Open. 2022 Mar 9;12(3):e053379. doi: 10.1136/bmjopen-2021-053379.

Authors

Ziwei Xi¹, Hong Qiu², Tingting Guo³, Yong Wang¹, Jianan Li⁴, Yang Li¹, Jianfeng Zheng¹, R Gao¹

Affiliations

¹ Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Coronary artery disease center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China qiuhong6780@sina.com.
³ Thrombosis Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Beijing, China.

Abstract

Objectives: To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI).

Design: Systematic review and meta-analysis of contemporary available evidence.

Setting: PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0.

Participants: Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included.

Primary and secondary outcome measures: The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up.

Results: A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I²=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I²=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I²=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I²=74.5%).

Conclusions: An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.

Keywords: coronary heart disease; epidemiology; myocardial infarction.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Female
Humans
Male
Percutaneous Coronary Intervention*
ST Elevation Myocardial Infarction*
Sex Characteristics
Treatment Outcome