title: Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome), Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marini
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.affiliation: Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.affiliation: Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarella
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Chiara
authors.affiliation: Department of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.affiliation: Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.affiliation: Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria, La Spezia, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Caretta
authors.affiliation: Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Lenatti
authors.affiliation: Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.
authors.forename: Michele Massimo
authors.initials: MM
authors.lastname: Gulizia
authors.affiliation: Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy centrostudi@anmco.it s.savonitto@asst-lecco.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
mesh_terms: D000367:Age Factors; D000368:Aged; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: ST‐segment elevation myocardial infarction; percutaneous coronary intervention; registry; sex