Abstract
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. 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 odds ratios (OR): 2.41, 95% confidence intervals (CI): 1.59-3.66], early (6.2% vs. 2.6%, P < 0.001; unadjusted OR: 2.4, 95% CI: 2.12-2.72) and late mortality (7.0% vs. 3.1%, P > 0.001; unadjusted OR: 2.33, 95% CI: 2.08-2.61) 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. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for younger women should be performed.