A systematic review and meta-analysis investigating gender differences in in-hospital, short-term and long-term outcomes among patients who underwent primary PCI.

Introduction: To assess how gender disparities impact major adverse cardiovascular events during hospitalization, as well as in the short and long term, among patients with ST-elevation myocardial infarction who undergo primary PCI.

Evidence acquisition: PubMed, Scopus and Cochrane database were searched for relevant studies. Studies were included if all comers with STEMI, reported gender specific patient characteristics, treatments and outcomes. Odds ratio and 95% confidence interval were calculated using random effect model.

Evidence synthesis: A total of 23 studies were included for the pooled meta-analysis. Average age of female at presentation was 68.61±3.91 years while in male was 60.83±2.48 years. In unadjusted analysis, female patients were at higher risk for mortality (OR=1.98, 95% CI: 1.71-2.30, P<0.0001, I²=35%) at hospitalization, (OR=2.25, 95% CI=1.75-2.88, P≤0.00001) at short term and (OR=1.76, 95% CI: 1.41-2.21, P<0.000, I²=68%) at long term. The adjusted analysis of major adverse cardiovascular events for short term (OR=1.09, 95% CI: 0.91-1.31, P=0.37, I²=76%) and long term (OR=1.05, 95% CI: 0.98-1.12, P=0.17, I²=37%) were not found significant between both genders. However, it remained significant during hospitalization (OR=1.12, 95% CI: 1.03-1.22, I²=15%, Tau²=0.00).

Conclusions: The findings of this comprehensive meta-analysis indicate higher major adverse cardiac events among women with STEMI who underwent PPCI. After adjusting for comorbidities, the difference between women and men showed insignificant at short term and long term but remained significant at in-hospital. Female patients exhibited a higher prevalence of cardiovascular risk factors than men. Implementing intensive cardiovascular risk reduction strategies in women may offer a pathway to address this gender disparity.