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Sex-related differences in ST-segment elevation myocardial infarction: A Portuguese multicenter national registry analysis

2025-03Journal article Open access
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datacite.subject.fosCiências Médicas::Ciências da Saúde
datacite.subject.sdg03:Saúde de Qualidade
datacite.subject.sdg17:Parcerias para a Implementação dos Objetivos
dc.contributor.authorGonçalves, Carolina Miguel
dc.contributor.authorCarvalho, Mariana
dc.contributor.authorVazão, Adriana
dc.contributor.authorCabral, Margarida
dc.contributor.authorMartins, André
dc.contributor.authorSaraiva, Fátima
dc.contributor.authorMorais, João
dc.contributor.editorOliveira, Mário
dc.date.accessioned2025-10-02T10:58:48Z
dc.date.available2025-10-02T10:58:48Z
dc.date.issued2025-03
dc.description
dc.description.abstractIntroduction and objectives Sex differences among patients with acute myocardial infarctions remain a matter of debate. Inequalities in presentation, diagnosis, treatment, and prognosis are frequently observed, contributing to a worse prognosis in women. The aim of this study was to investigate sex-related differences in Portuguese ST-segment elevation myocardial infarction (STEMI) patients. Methods The authors conducted a retrospective analysis of STEMI patients included in the Portuguese Registry on Acute Coronary Syndromes, between October 2010 and 2022. The two co-primary endpoints were in-hospital and one-year mortality. Results A total of 14 470 STEMI patients were studied. Women were underrepresented with 3721 individuals (25.7%). They were significantly older (70 vs. 62 years, p<0.001), with higher prevalence of cardiovascular risk factors, and underwent less frequently coronary angiography (84.4% vs. 88.5%, p<0.001) and guideline-directed medical therapy (e.g., aspirin 92.5% vs. 95.4%, beta blockers 79.2% vs. 83%, p<0.001). Furthermore, they experienced more complications, such as congestive heart failure (23.4% vs. 14.6%), ischemic stroke (47% vs. 40%), and in-hospital mortality (8.5% vs. 4.1%) (p<0.001 for all comparisons). Similarly, they presented higher one-year mortality (11.5% vs. 6.3%, p<0.001). However, after a multivariate analysis testing significant clinical variables, female sex remained an independent predictor for in-hospital (odds ratio=1.633; 95% CI [1.065–2.504]; p=0.025), but not for one-year mortality. Conclusions This analysis reveals sex-related disparities in Portuguese STEMI patients. Despite limitations inherent to registry-based analysis, women were significantly older, with increased cardiovascular risk, less treated, and with higher in-hospital mortality. These disparities should be a concern for clinicians to further improve outcomes and move toward equitable medical care.eng
dc.description.abstractIntrodução e objetivos As diferenças entre sexos nos doentes com enfarte agudo do miocárdio (EAM) são um tópico controverso. São frequentemente descritas disparidades na apresentação, no diagnóstico e no tratamento, as quais contribuem para um pior prognóstico nas mulheres. O objeto desta análise foi determinar estas diferenças no EAM com supradesnivelamento do segmento ST (STEMI). Métodos Os autores realizaram uma análise retrospetiva de doentes com STEMI incluídos no Registo Português de Síndromes Coronárias Agudas, entre outubro de 2010 e 2022. Foram definidos dois endopoints primários: mortalidade intra-hospitalar e mortalidade a um ano. Resultados Foram incluídos 14 470 STEMI. O sexo feminino estava sub-representado (3.721 doentes, 25,7%). As mulheres tinham uma idade superior (70 versus 62 anos, p < 0,001), com maior prevalência de fatores de risco cardiovascular, sendo menos submetidas a angiografia coronária (84,4% versus 88,5%, p < 0,001) e a terapêutica médica (aspirina 92,5% versus 95,4%, beta bloqueantes 79,2% versus 83%, p < 0,001). O sexo feminino apresentou mais complicações: insuficiência cardíaca congestiva (23,4% versus 14,6%), acidente vascular cerebral isquémico (47 versus 40%), e mortalidade intra-hospitalar (8,5% versus 4,1%) (p < 0,001 para todas as comparações). A mortalidade a um ano foi superior nas mulheres (11,5% versus 6,3, p < 0,001). Após análise multivariada, o sexo feminino manteve-se preditor independente de mortalidade intra-hospitalar (OR = 1,633; CI 95% [1,065-2,504]; p = 0,.025), mas não a um ano. Conclusão O presente estudo, em Portugal, revela múltiplas diferenças entre sexos no STEMI. Apesar das limitações inerentes às análises baseadas em registos nacionais, as mulheres têm idade e risco cardiovascular superior, sendo menos tratadas, com mortalidade superior. Estas desigualdades devem ser uma preocupação para a comunidade médica de modo a melhorar outcomes e a proporcionar cuidados médicos equitativos.por
dc.identifier.citationMiguel Gonçalves C, Carvalho M, Vazão A, Cabral M, Martins A, Saraiva F, Morais J; ProACS Investigators. Sex-related differences in ST-segment elevation myocardial infarction: A Portuguese multicenter national registry analysis. Rev Port Cardiol. 2025 Mar;44(3):167-176. English, Portuguese. doi: 10.1016/j.repc.2024.06.005. Epub 2024 Aug 29. PMID: 39216527.
dc.identifier.doi10.1016/j.repc.2024.06.005
dc.identifier.eissn2174-2030
dc.identifier.issn0870-2551
dc.identifier.urihttp://hdl.handle.net/10400.8/14185
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier
dc.relation.hasversionhttps://www.revportcardiol.org/pt-sex-related-differences-in-st-segment-elevation-articulo-S0870255124002725
dc.relation.ispartofRevista Portuguesa de Cardiologia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectDiagnosis
dc.subjectMyocardial infarction
dc.subjectPrognosis
dc.subjectSex differences
dc.subjectSTEMI
dc.subjectTreatment
dc.subjectDiagnóstico
dc.subjectDiferenças entre sexos
dc.subjectEnfarte agudo do miocárdio
dc.subjectPrognóstico
dc.subjectTratamento
dc.titleSex-related differences in ST-segment elevation myocardial infarction: A Portuguese multicenter national registry analysiseng
dc.title.alternativeAs diferenc¸as entre os sexos no enfarte agudo do miocárdio com supradesnivelamento do segmento ST: um estudo baseado no registo nacional multicêntrico portuguêspor
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage176
oaire.citation.issue3
oaire.citation.startPage167
oaire.citation.titleRevista Portuguesa de Cardiologia
oaire.citation.volume44
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMorais
person.givenNameJoão
person.identifier.ciencia-id3614-652A-118E
person.identifier.orcid0000-0003-3406-2878
relation.isAuthorOfPublication3bc0f910-a460-461f-863a-1ca701ee597f
relation.isAuthorOfPublication.latestForDiscovery3bc0f910-a460-461f-863a-1ca701ee597f

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