title: Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis.
abstract: OBJECTIVE
  Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) have improved in the past 2 decades, a sex disparity exists in survival, with women having higher mortality than men.
  
  
  OBJECTIVE
  To conduct a meta-analysis of observational studies that examined differences in mortality by sex in patients with STEMI treated with primary percutaneous coronary intervention (PPCI).
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane central, and electronic databases were searched for relevant studies in all languages and without time restriction.
  
  
  METHODS
  Studies were included if (1) they studied patients who presented with STEMI, (2) primary percutaneous coronary intervention (PPCI) was the treatment for STEMI, (3) PPCI was performed within 12 hours of symptom onset, and (4) sex-specific in-hospital and/or 1-year mortality were reported.
  
  
  METHODS
  Two investigators independently reviewed retrieved citations and assessed eligibility. Discrepancies were resolved by consensus. Quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale for cohort studies. Data were pooled using a random-effects model.
  
  
  METHODS
  Sex-specific in-hospital and 1-year all-cause mortality. Risk ratios (RRs) of mortality were used for these 2 time points, if reported.
  
  
  RESULTS
  Of the 149 studies identified, 35 met inclusion criteria, representing 18 555 women and 49 981 men. In the unadjusted analyses, women were at a higher risk for in-hospital (RR, 1.93; 95% CI, 1.75-2.14 [P < .001, I2 = 14%]) and 1-year all-cause mortality (RR, 1.58; 95% CI, 1.36-1.84 [P < .001, I2 = 51%]) compared with men. However, when adjusted RRs were used, the association between women and higher risk of all-cause mortality was attenuated but still significantly elevated for in-hospital mortality (RR, 1.48; 95% CI, 1.07-2.05 [P = .02, I2 = 56%]), but the higher risk for 1-year mortality in women was no longer significant (RR, 0.90; 95% CI, 0.69-1.17 [P = .42, I2 = 58%]).
  
  
  CONCLUSIONS
  An increased mortality in women with STEMI treated with PPCI was detected in this large meta-analysis but is likely confounded by baseline cardiovascular risk factors and the differences in clinical profile of male and female patients with STEMI. Intensive cardiovascular risk modification efforts in women may help to reduce this sex disparity.
authors.affiliation: Department of Cardiovascular Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania2The Commonwealth Medical College, Scranton, Pennsylvania.
authors.forename: Samir Bipin
authors.initials: SB
authors.lastname: Pancholy
authors.affiliation: Department of Cardiovascular Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania.
authors.forename: Ghanshyam Palamaner Subash
authors.initials: GP
authors.lastname: Shantha
authors.affiliation: Department of Cardiovascular Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania.
authors.forename: Toralben
authors.initials: T
authors.lastname: Patel
authors.affiliation: Johns Hopkins Weight Management Center, Johns Hopkins University, Baltimore, Maryland4Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cheskin
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D064887:Observational Studies as Topic; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012727:Sex Characteristics