STEMI in Women

Background: Cardiovascular disease (CVD) is the leading cause of mortality in Indian women. Acute coronary syndromes (ACS), including unstable angina (UA), non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), represent a large portion of the clinical presentation of coronary artery disease (CAD) in Indians. Despite the importance of CAD for women, there is persistent perception that CAD is a man’s disease. We have been interested in coronary artery disease in women and thereafter we observed interesting data about STEMI in women, particularly highlighting the incidence, risk factors, interventional procedure with immediate and long term outcome.

Methods: We studied clinical and angiographic profiles of 100 women admitted with STEMI who underwent coronary angiography and angioplasty over a period of 5 years at Nanavati Hospital, Mumbai, India. The objectives were to examine the distribution of risk factor and coronary angiographic patterns of CAD in women presenting with STEMI.

Results: It was observed that myocardial infarction is most commonly involving women between the age 50 to 80 years. Diabetes mellitus and Hypertension were found to be most common risk factors involved in development of myocardial infarction in obese females. Most common presentation of STEMI was inferior wall MI. Most common coronary angiography finding was multi vessel disease.

Conclusion: The clinical presentation of myocardial infarction in women varies from mild chest discomfort to severe unstable angina. Primary angioplasty is the gold standard treatment for such patients. Data about gender as an independent prognostic factor for death is conflicting. Women usually present at a later age with atypical symptoms and have higher rates of comorbidity, which translates to a worse prognosis post-ACS than men. As this study is based on experience at single center, various biases may be possible.