Background: Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction (STEMI), are age dependent.
Purpose: The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide registry.
Methods: This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early (30 days) and late (12 months) mortality between gender to examine the gender-age interaction in multivariable models.
Results: In younger women (<60 years), in-hospital (5.8% vs. 2.5%, p<0.001; unadjusted OR 2.41, 95% CI 1.59 to 3.66), early (6.2% vs. 2.6%, p<0.001; unadjusted OR 2.4, 95% CI 2.12 to 2.72) and late mortality (7.0% vs. 3.1%, p>0.001; unadjusted OR 2.33, 95% CI 2.08 to 2.61) were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer related to gender in any age groups.
Conclusions: Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. More intensive treatment strategies based on gender-age differences are needed in these patients.