Understanding the NSW STEMI Landscape (2011–2020)
Cardiovascular disease remains a leading cause of death for all adults, yet women with ST‑elevation myocardial infarction (STEMI) have historically faced under-recognition and undertreatment. A comprehensive retrospective cohort study of STEMI admissions in New South Wales (NSW), Australia, from 2011 to 2020 sheds light on how sex differences in management and outcomes evolved over a decade of policy changes, awareness campaigns, and system‑level improvements.
Researchers analyzed first STEMI admissions among adults (18+) across public and private NSW hospitals using linked administrative data, with outcomes tracked up to 12 months post-discharge. The study confirms earlier findings: women were older on average, had more comorbidities, and experienced higher rates of adverse outcomes. Yet, crucially, the pace of improvement in care and prognosis was steeper for women, narrowing some of the historic treatment gaps.
Key Patient Characteristics
Among 29,435 initial STEMI admissions, 28.8% were women and 71.2% were men. Women were older at presentation (mean age 72.4 vs 63.6 years) and a larger share were aged 85+ (25.6% vs 7.2%). Comorbidity burden was higher in women (mean Charlson index 2.1 vs 1.8), with more prior heart failure, cerebrovascular disease, dementia, chronic pulmonary disease, and diabetes. Socioeconomic disadvantage affected a substantial portion of the cohort, underscoring the intersection of gender, health, and social determinants.
Trends in Invasive Care
Across the study period, use of invasive strategies increased for all patients, but the gains were particularly notable for women. Key findings include:
- Angiography within seven days rose from 75.5% (2011–2013) to 89.7% (2019–2020).
- PCI within seven days rose from 46.4% to 67.4% over the same span.
- Females consistently had lower rates of angiography, PCI, and even CABG than males, yet the year-by-year improvements were faster for women. After adjustment for age, ICU admission, and comorbidity, women gained about 2.7 percentage points per year in angiography versus 1.5 points for men, and 3.2 points per year in PCI versus 2.5 for men.
Importantly, the convergence was stronger among those under 85 years; older patients still displayed slower convergence, highlighting ongoing age‑related disparities.
Outcomes: Mortality and Major Adverse Events
In the first year after discharge, 16.0% experienced major adverse cardiovascular events (MACE) and 10.3% died from any cause. While overall MACE declined modestly over time, mortality fell more rapidly among women, reducing the historical gap. Specifically, mortality declined by a larger annual margin for women, suggesting that improved access to and use of reperfusion therapies benefited female patients disproportionately at the population level.
Details include:
- ICU admission was less common for women (8.1% vs 9.5%), yet cardiovascular death and all-cause mortality remained higher among women in the early period.
- From 2011–2013 to 2019–2020, deaths fell from 15.8% to 3.5% in the NSW STEMI cohort, with women showing a relatively faster improvement in several mortality metrics when adjusted for age and comorbidity.
Interpreting the Gaps and the Progress
The study reinforces a persistent but narrowing sex gap in STEMI care and outcomes. Several factors may underpin the observed improvements: a nation‑wide push for public education on heart disease in women, hospital system reforms, and the expansion of primary PCI networks. A focused protocol—such as ensuring rapid activation of catheterization labs and adopting patient‑centered STEMI pathways—can further reduce residual disparities and boost outcomes for women of all ages.
Implications for Policy and Practice
Key messages for clinicians, health systems, and policymakers include:
- Maintain and strengthen networks that ensure rapid reperfusion for all STEMI patients, with explicit attention to reducing sex-based delays.
- Continue campaigns that raise awareness of heart disease in women among both the public and medical staff, complementing guidelines that emphasize equal benefit from reperfusion strategies.
- Invest in sex-specific data collection and analysis to monitor trends, identify remaining gaps, and tailor interventions accordingly.
Conclusion
The NSW 2011–2020 STEMI study demonstrates that sex differences in management and outcomes can be narrowed with sustained, system-level efforts. While gaps remain—particularly among older women—the overall trajectory is one of meaningful improvement for female patients, signaling that targeted strategies can equally benefit all people facing STEMI.
