Ce que le registre e-MUST dit de l’infarctus de la femme

Abstract

The issue of gender in acute myocardial infarction (AMI) emerged in the literature over 25 years ago. It became evident that, all other factors being equal, women with AMI had higher mortality rates than men. The e-MUST registry, which includes patients with ST-segment elevation myocardial infarction (STEMI) of less than 24 hours’ duration managed by one of the 39 Mobile Emergency and Resuscitation Services (SMUR) in the Île-de-France region, has allowed for numerous gender-focused analyses. Key findings include: [1] higher mortality in women: women experiencing AMI have a higher mortality risk (OR = 1.4; 95% CI: 1.1–1.8) compared to men [2]. Younger age of onset in women: while the average age at AMI onset increased by 2.9 years in men between 2002 and 2021 (from 57.6 to 60.5 years; p < 0.05), it decreased by 3.1 years in women (from 73.7 to 70.6 years; p < 0.0001) [3]. Advanced age in a subset of women: women represented 22% of the total registry population but accounted for over 60% of nonagenarian patients. In this very elderly subgroup, the rate of myocardial reperfusion decisions rose from 50% in the early 2000s to over 90% by the early 2020s. This intervention was associated with a 58% reduction in mortality [4]. Nontraditional risk profiles: women with AMI often presented without traditional cardiovascular risk factors, or with risk factors not routinely screened for [5]. Circadian patterns and delayed calls: AMI in women frequently occurred in the early morning, peaking at 08:00. Call delays to emergency services increased with age and nighttime onset, reaching up to 300 minutes in women over 65 experiencing chest pain at 1 a.m [6]. Prehospital management: except for a slightly lower rate of myocardial reperfusion in women (93% vs. 96% in men; p < 0.0001), prehospital management, including anticoagulant and antiplatelet therapy, was comparable between genders [7]. Gender bias in medical regulation: analysis of SAMU call regulation revealed that both the patient’s and the physician’s gender influenced the decision to dispatch a SMUR unit—ranging from 49% when both regulator and patient were men to just 18% when both were women [8]. Need for targeted approaches: these findings underscore the necessity for increased awareness, dedicated training, and gender-specific emergency care protocols to improve outcomes in women with AMI.