Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction Leonardo De Luca, MD, PhD, FACC, FESC; Marco Marini, MD; Lucio Gonzini, BSc; Alessandro Boccanelli, MD; Gianni Casella, MD; Francesco Chiarella, MD; Stefano De Servi, MD, FESC; Antonio Di Chiara, MD; Giuseppe Di Pasquale, MD, FACC, FESC; Zoran Olivari, MD; Giorgio Caretta, MD; Laura Lenatti, MD; Michele Massimo Gulizia, MD, FACC, FESC; Stefano Savonitto, MD, FESC Background-—Age- and sex-specific differences exist in the treatment and outcome of ST-elevation myocardial infarction (STEMI). We sought to describe age- and sex-matched contemporary trends of in-hospital management and outcome of patients with STEMI. Methods and Results- —We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age- and sex-matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in-hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07–1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07–1.93, P=0.009) were found to be significantly associated with in-hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61). Conclusions-—Despite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in-hospital mortality than men, irrespective of age. ( J Am Heart Assoc. 2016;5:e004202 doi: 10.1161/JAHA.116.004202) Key Words: percutaneous coronary intervention • registry • sex • ST-segment elevation myocardial infarction A fter an acute myocardial infarction, women continue to experience higher mortality than men, despite improve- ments in reperfusion therapy. 1,2 This worse outcome is attributed, at least in part, to older age at presentation, though a recent meta-analysis of observational studies has reported that women have a higher risk of in-hospital mortality even after adjustment for baseline differences. 3 Over the last 15 years, there has been a progressive improvement in reperfusion therapy for ST-elevation myocardial infarction (STEMI), with a shift from fibrinolytic therapy to primary percutaneous coronary intervention (pPCI) and an overall increase in reperfusion rates due to the organization of STEMI networks. These improvements in STEMI treatment had the potential to reduce the gap in STEMI outcomes among women, given that in the lytic era they consistently received less treatment and were more exposed to adverse bleeding events following fibrinolysis. On the other hand, use of pPCI virtually eliminates the risk of intracranial From the Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome), Italy (L.D.L.); Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy (M.M.); ANMCO Research Center, Florence, Italy (L.G.); Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Rome, Italy (A.B.); Department of Cardiology, Maggiore Hospital, Bologna, Italy (G. Casella, G.D.P.); Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy (F.C.); Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (S.D.S.); Division of Cardiology, Ospedale Sant’Antonio Abate, Tolmezzo, Italy (A.D.C.); Department of Cardiology, Ca’ Foncello Hospital, Treviso, Italy (Z.O.); Division of Cardiology, Sant’Andrea Hospital, ASL 5 Liguria, La Spezia, Italy (G. Caretta); Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy (L.L., S.S.); Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy (M.M.G.). Correspondence to: Stefano Savonitto, MD, FESC, Division of Cardiology, Ospedale A. Manzoni, Via dell’Eremo, 9/11 - 23900 Lecco, Italy. E-mails: centrostudi@anmco.it or s.savonitto@asst-lecco.it Received July 6, 2016; accepted October 7, 2016. ª 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. DOI: 10.1161/JAHA.116.004202 Journal of the American Heart Association 1 ORIGINAL RESEARCH by guest on September 1, 2017 http://jaha.ahajournals.org/ Downloaded from