Clinical Profiles, Outcomes, and Sex Differences of Patients With STEMI: Findings From the NORIN-STEMI Registry

Arman Qamar; Kirtipal Bhatia; Sameer Arora; Michael Hendrickson; Puneet Gupta; Amber Fatima; Girish Mp; Ankit Bansal; Vishal Batra; Mark J Ricciardi; Cindy L Grines; Jamal Yusuf; Saibal Mukhopadhyay; Sidney C Smith Jr; Sanjay Tyagi; Deepak L Bhatt; Martha Gulati; Mohit D Gupta

doi:10.1016/j.jacasi.2022.12.011

Clinical Profiles, Outcomes, and Sex Differences of Patients With STEMI: Findings From the NORIN-STEMI Registry

JACC Asia. 2023 Apr 4;3(3):431-442. doi: 10.1016/j.jacasi.2022.12.011. eCollection 2023 Jun.

Authors

Arman Qamar¹, Kirtipal Bhatia², Sameer Arora³, Michael Hendrickson⁴, Puneet Gupta⁵, Amber Fatima⁶, Girish Mp⁷, Ankit Bansal⁷, Vishal Batra⁷, Mark J Ricciardi¹, Cindy L Grines⁸, Jamal Yusuf⁷, Saibal Mukhopadhyay⁷, Sidney C Smith Jr³, Sanjay Tyagi⁷, Deepak L Bhatt⁹, Martha Gulati¹⁰, Mohit D Gupta⁷

Affiliations

¹ Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA.
² Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York, USA.
³ Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
⁴ Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Cardiology, Janakpuri Superspeciality Hospital, New Delhi, India.
⁶ Division of Cardiology, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, Illinois, USA.
⁷ Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
⁸ Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, Georgia, USA.
⁹ Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA.
¹⁰ Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.

Abstract

Background: Low- and middle-income countries account for most of the global burden of coronary artery disease. There is a paucity of data regarding epidemiology and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in these regions.

Objectives: The authors studied the contemporary characteristics, practice patterns, outcomes, and sex differences in patients with STEMI in India.

Methods: NORIN-STEMI (North India ST-Segment Elevation Myocardial Infarction Registry) is an investigator-initiated prospective cohort study of patients presenting with STEMI at tertiary medical centers in North India.

Results: Of 3,635 participants, 16% were female patients, one-third were <50 years of age, 53% had a history of smoking, 29% hypertension, and 24% diabetes. The median time from symptom onset to coronary angiography was 71 hours; the majority (93%) presented first to a non-percutaneous coronary intervention (PCI)-capable facility. Almost all received aspirin, statin, P2Y₁₂ inhibitors, and heparin on presentation; 66% were treated with PCI (98% femoral access) and 13% received fibrinolytics. The left ventricular ejection fraction was <40% in 46% of patients. The 30-day and 1-year mortality rates were 9% and 11%, respectively. Compared with male patients, female patients were less likely to receive PCI (62% vs 73%; P < 0.0001) and had a more than 2-fold greater 1-year mortality (22% vs 9%; adjusted HR: 2.1; 95% CI: 1.7-2.7; P < 0.001).

Conclusions: In this contemporary registry of patients with STEMI in India, female patients were less likely to receive PCI after STEMI and had a higher 1-year mortality compared with male patients. These findings have important public health implications, and further efforts are required to reduce these gaps.

Keywords: STEMI; cardiovascular disease; disparities; female patients; sex differences.