Gender differences in patients presenting with non-ST segment elevation myocardial infarction in the STAR registry

Abstract

In most acute coronary artery (ACS) related literature, the female gender constitutes a smaller proportion. This study is based on gender-specific data in the Saudi Acute Myocardial Infarction Registry Program (STARS-1 Program). A prospective multicenter study, conducted with patients diagnosed with ACS in 50 participating hospitals. In total, 762 (34.12%) patients were diagnosed with non-ST segment elevation myocardial infarction. Of this group, only 164 (21.52%) were women. The mean age (64.52 ± 12.56 years) was older and the mean body mass index (BMI) was higher (30.58 ± 6.23). A significantly proportion was diabetic or hypertensive; however, a smaller proportion was smoking. Hyperlipidemia was present in 48%. The history of angina/MI/stroke and revascularization was similar, except for renal impairment. The presentation was atypical as only 70% presented with chest pain, and the rest with shortness of breath or epigastric pain. At presentation, the female group were more tachycardiac, had higher blood pressure, and a higher incidence of being in class 11-111 Killip heart failure. Only 32% had a normal systolic function, and the majority had either mild or moderate systolic dysfunction. In particular, the rate of percutaneous coronary intervention was similar. The in-hospital mortality was similar (5%), with more women diagnosed with atrial fibrillation and heart failure at follow-up. Women had a higher prevalence of risk factors affecting the presentation and morbidity but not mortality. Improving these risk factors and the lifestyle is a priority to improve the outcome and decrease morbidity.