Sex differences in hospital mortality with the myocardial infarction code

Background: There are differences in acute coronary syndrome (ACS), with a worse prognosis in women.Objective: To evaluate sex differences in presentation, management of the myocardial infarction code and in-hospital mortality in the National Registry of Acute Coronary Syndromes.Material and methods: A total of 62,118 adults (74% men and 26% women) with ST elevation myocardial infarction (STEMI) or non ST elevation myocardial infarction (NSTEMI) treated in 177 hospitals were included.Treatment and prognosis were compared.Results: Women had higher comorbidity and lower smoking rates.STEMI was more prevalent in men (73.0% vs. 63.6%), and Non ST Elevation-Acute Coronary Ayndrome (NSTE-ACS) was more prevalent in women (36.4% vs. 27.0%).Under the heart attack code, reperfusion rates were higher in men: percutaneous coronary intervention (PCI) 28.3% vs. 27.9%,fibrinolytic therapy (FT) 36.4% vs. 31.9%,and pharmaco-invasive strategy (PIS) 7.9% vs. 7.2%, respectively; non-reperfusion rates were higher in women (27.3% vs. 33%; p < 0.0001).Complications were more frequent in women, and mortality was also higher in women (15.3% vs. 10.4%;OR: 1.56; 95% CI: 1.48-1.65).In logistic regression, female sex, age, diabetes, and hypertension independently predicted in-hospital death.Conclusions: Women received less reperfusion, greater comorbidity and mortality, therefore timely and equitable care in the myocardial infarction code must be guaranteed.