Long-term clinical impact of sex disparities in patients with ST elevation acute myocardial infarction: a systematic review and meta-analysis of adjusted observational studies
Objectives We aimed to address an evidence gap by investigating the clinical impact of sex differences on long-term outcomes after primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction.Design Systematic review and meta-analysis.Data sources Medline, Scopus an...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/7/e096334.full |
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| Summary: | Objectives We aimed to address an evidence gap by investigating the clinical impact of sex differences on long-term outcomes after primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction.Design Systematic review and meta-analysis.Data sources Medline, Scopus and EMBASE were searched through August 2024. Eligibility criteria for selecting studies. We included adjusted observational studies reporting HRs, comparing long-term clinical outcomes (beyond 1 year) between women and men undergoing pPCI for ST-elevation myocardial infarction.Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias using the ROBINS I (Risk Of Bias In Non-randomised Studies - of Interventions) tool. Data were pooled using generic inverse-variance weighting, computing risk estimates with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic).Results 22 observational studies globally encompassing 358 140 patients (169 659 women vs 188 490 men) were included in the quantitative analysis. After a median follow-up of 3.3 years, no significant differences in terms of all-cause mortality were reported after multivariable adjustments (adjusted HR, adjHR 1.06, 95% CI 0.99 to 1.14, p=0.10). Women had a higher rate of cardiac death compared with men after multivariable adjustments (adjHR 1.86, 95% CI 1.25 to 2.77, p=0.002). No other significant differences in terms of recurrent MI, stent thrombosis and target vessel revascularisation persisted between women and men after multivariable adjustments.Conclusions Women undergoing pPCI for acute ST-elevation myocardial infarction experience an increased risk of cardiac death compared with men after a long-term follow-up.PROSPERO registration number CRD42024580932. |
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| ISSN: | 2044-6055 |