While little is known about perceived or existing gender differences in global STEMI care, findings from ACC's Global Heart Attack Treatment Initiative (GHATI) presented at ACC.22 suggest that significantly fewer women in low-middle income nations are treated for STEMI compared with men, as well as their U.S. women counterparts.

Researchers evaluated STEMI patient data from October 2019 to December 2020 across 18 hospitals in low-middle income countries that are participating in ACC's GHATI initiative. They then compared the findings with all acute myocardial infarctions (AMIs) included in ACC's Chest Pain – MI Registry, part of the College's suite of NCDR registries. Comparisons between percentage of female subjects with STEMI reported by quarter in GHATI, and AMIs in the registry were undertaken using a Mann-Whitney Test model.

Findings from that study revealed that only about 19% of STEMI patients treated at GHATI sites were women, about half of the proportion of women treated for myocardial infarction (MI) at U.S. hospitals, said Cesar Herrera, MD, FACC, Americas Representative to ACC's Assembly of International Governors and the chair of GHATI. He said further research is needed to understand what may be driving this disparity, though factors such as attitudes and behaviors, access to transportation and access to care could play a role in limiting the number of women who make it to the hospital after experiencing MI symptoms in low- and middle-income countries

GHATI, which launched in 2019, uses data collection and localized education around guideline-directed medical therapy to improve MI outcomes in low-middle income countries by working directly with medical centers on targeted improvements. To participate in the program, which is free and voluntary, hospitals agree to collect certain data points related to STEMI care and then share the deidentified data with GHATI.

To date, the program has tracked STEMI treatment metrics and outcomes for more than 4,000 patients at 39 medical centers in 18 countries on five continents. Two-year outcomes from the program, also presented at ACC.22 as part of the Late-Breaking Clinical Trial lineup, show significant improvements in key clinical endpoints, including cardiogenic shock upon arrival at the hospital, cardiac arrest, left ventricular ejection fraction below 40% and survival at discharge, as a result of the program. Researchers also observed a continued rise in the adherence to guideline-directed medical therapy, with up to 92% of cases receiving this level of care – up from 90% after the program's first year. Other important findings from the program include a sustained high rate of reperfusion therapy, which was reported in 95% of STEMI cases, as well as a 75% success rate in patients undergoing PCI, within 90 minutes of first medical contact.

"We're very happy to see the trends of improvement over the two-year period of data acquisition," said Herrera. "Measuring these data points, offering guidance to participating hospitals and encouraging them to follow guidelines seems to be working. To see the continuing improvements over time is pretty amazing."

Looking ahead, Herrera notes opportunities still exist for further improvement in door-to-balloon times. He also highlights opportunities to improve the time it takes for patients to get to the hospital after first medical contact, which can be quite long in many countries, especially those without an emergency response service like the 911 service used in the U.S. He adds that in some places, practices may be constrained by technological limitations, such as a lack of echocardiographic machines for assessing left ventricular ejection fraction.

Clinical Topics: Stable Ischemic Heart Disease, Vascular Medicine, Chronic Angina

Keywords: ACC Annual Scientific Session, ACC22, ST Elevation Myocardial Infarction, Myocardial Infarction

< Back to Listings