Gender-based differences among ST-elevation myocardial infarction patients in Egypt: secondary analysis from the ACCA-EAPCI ESC-STEMI registry

Abstract

Background: Gender-based variations in the management and prognosis of ST-segment elevation myocardial infarction (STEMI) have been documented globally, with females often experiencing worse outcomes than males. However, limited data are available on these disparities in Egypt. This research aims to evaluate gender-based variations in the management and short-term findings of STEMI patients in Egypt. Results: The study analyzed 1,356 STEMI patients, of whom 250 (18.44%) were female. Women were significantly older than men (61.7 ± 11.3 vs. 55.9 ± 11 years; p < 0.001) and had a greater prevalence of comorbidities, comprising diabetes (62.8% vs. 35.3%; p < 0.001), hypertension (55.2% vs. 33%; p < 0.001), and prior stroke/transient ischemic attack (7.2% vs. 3.3%; p < 0.01). Women experienced longer delays in seeking care (symptom onset to first medical contact time: 4.2 ± 6.1 vs. 3.1 ± 3.7 h; p < 0.001) and tended to show up with advanced heart failure (Killip class III/IV: 12.8 vs. 6.9%; p = 0.005). Despite similar rates of primary percutaneous coronary intervention utilization, women had greater rates of in-hospital mortality (7.6 vs. 4.0%; p = 0.01). Multivessel disease was less common in women, but they had a greater prevalence of right coronary artery involvement as the culprit lesion (32.9 vs. 21.7%; p = 0.002). Medication prescription rates at discharge revealed that women received high-intensity statins (93.2 vs. 96.1%; p = 0.04) and ticagrelor (3.6 vs. 7.8%; p = 0.01) less commonly. Conclusions: Egyptian women with STEMI exhibit significant delays in presentation, a greater burden of comorbidities, and worse in-hospital outcomes compared to men.