A Global Systematic Review and Meta-Analysis of Sex Disparities in Outcomes in Patients with ST-segment Elevation Myocardial Infarction

BackgroundSex disparities in the delivery of care and in-hospital outcomes following ST-segment elevation myocardial infarction (STEMI) remain a global concern. We performed an updated global meta-analysis comparing clinical outcomes between males and females with STEMI. MethodsThis study was conducted according to PRISMA guidelines (PROSPERO CRD42024612510). We searched major electronic databases from 1st January 2000 to 7th November 2024. Pairwise meta-analysis was performed on outcomes related to time-to-therapy, in-hospital outcomes, and optimal therapy, with subgroup analyses of geographic regions. Meta-regression was performed to evaluate heterogeneity. ResultsA total of 69 studies, involving 891,585 patients (262,773 females; 628,401 males) were included. Males were younger (MD -7.387 years), less likely to have diabetes, hypertension, and prior stroke, had significantly lower risk of in-hospital mortality (RR 0.56, 95%CI 0.53 to 0.61, P<0.05) and major bleeding (RR 0.59, 95%CI 0.50 to 0.71, P<0.05). Males had significantly shorter time to first medical contact (MD - 32.42mins), door-to-balloon (MD -6.17mins) and door-to-needle (MD -5.53mins) times, more likely to undergo PCI (OR 1.34, 95%CI 1.20 to 1.48, P<0.05), receive P2Y12 inhibitors (OR 1,52, 95%CI 1.04 to 2.23, P=0.03), GP IIb/IIIa inhibitors (OR 1.30, 95%CI 1.14 to 1.49, P<0.05), and ACE inhibitors (OR 1.41, 95%CI 0.92 to 2.17, P=0.11). No differences were observed for aspirin and beta-blocker use. Meta-regression showed female sex ({beta} = 1.40) and DM ({beta} = 0.78) were positively correlated with mortality. ConclusionFemales with STEMI experience longer treatment delays, worse in-hospital outcomes, and suboptimal care. There is an urgent need to address sex disparities in STEMI care.