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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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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| author | Massimo Mancone Ovidio De Filippo Carmine Dario Vizza Giulio Stefanini Riccardo Improta Gianluca Di Pietro Gennaro Sardella Fabrizio D’Ascenzo Lucia Ilaria Birtolo Emanuele Bruno |
| author_facet | Massimo Mancone Ovidio De Filippo Carmine Dario Vizza Giulio Stefanini Riccardo Improta Gianluca Di Pietro Gennaro Sardella Fabrizio D’Ascenzo Lucia Ilaria Birtolo Emanuele Bruno |
| author_sort | Massimo Mancone |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-dc9547ac5f7c437592c2e154e2be1066 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-dc9547ac5f7c437592c2e154e2be10662025-08-20T03:51:25ZengBMJ Publishing GroupBMJ Open2044-60552025-07-0115710.1136/bmjopen-2024-096334Long-term clinical impact of sex disparities in patients with ST elevation acute myocardial infarction: a systematic review and meta-analysis of adjusted observational studiesMassimo Mancone0Ovidio De Filippo1Carmine Dario Vizza2Giulio Stefanini3Riccardo Improta4Gianluca Di Pietro5Gennaro Sardella6Fabrizio D’Ascenzo7Lucia Ilaria Birtolo8Emanuele Bruno9Department of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyDepartment of Cardiology, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, ItalyDepartment of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyDepartment of Biomedical Sciences, Humanitas University, Milan, ItalyDepartment of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyDepartment of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyDepartment of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyDepartment of Cardiology, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, ItalyDepartment of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyDepartment of Clinical, Internal,Anesthesiological and Cardiovascular Sciences, Universita degli Studi di Roma La Sapienza, Rome, ItalyObjectives 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.https://bmjopen.bmj.com/content/15/7/e096334.full |
| spellingShingle | Massimo Mancone Ovidio De Filippo Carmine Dario Vizza Giulio Stefanini Riccardo Improta Gianluca Di Pietro Gennaro Sardella Fabrizio D’Ascenzo Lucia Ilaria Birtolo Emanuele Bruno 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 BMJ Open |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://bmjopen.bmj.com/content/15/7/e096334.full |
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