We evaluated in-hospital mortality and long-term clinical outcomes of female patients following primary angioplasty for ST-elevation MI (STEMI) via the radial route as default, as compared to male patients.  

Retrospective cohort analysis of thedemographics, clinical characteristics, primary angioplasty results, in –hospital and follow up results of 419 consecutive patients - 333 (79.5 %) malesand 86 (20.5 %) females, presenting with STEMI treated by primary angioplastyat the cardiology unit of a tertiary care center in India from 01^stJan 2011 to 10^th Mar 2019.

At presentation, the mean age of female patients was higher (65.4 + 9.9 vs. 58.9 + 11.9, p < 0.001). Anemia, hypertension, diabetes mellitus and dyslipidemia were more common in females, whereas smoking was more frequent in males (p < 0.05). Prior history of CABG, CVA, and PCI was more common in males (p < 0.05). More females than males presented in cardiogenic shock, pulmonary oedema, whereas more males presented in complete heart block (p<0.05). Renal insufficiency was more frequent in females (p<0.05). 
The pain-to-balloon time was significantly longer in females due to atypical presenting symptoms and delay in seeking medical help (p <0.05). Door-to-balloon times were similar in both sexes (36 + 22 mins). Radial route was the default one used in 85% of patients. Femoral was used only in patients with cardiogenic shock requiring IABP and in access site crossover. 
Incidence of multivessel disease was significantly higher in females (p < 0.05). Glycoprotein IIb/IIIa inhibitors were used in 79.0% females and 92% males. In-hospital mortality and major cardiac events, stroke, cardiogenic shock and major non-access site bleeding were more frequent in women (p<0.05). 30-day mortality due to cardiovascular events (in-hospital and out-of-hospital) was 5.5% (23 patients), being significantly higher in females (9.8 % vs. 4.7%, p < 0.001). Repeat hospitalization for cardiovascular causes and repeat revascularization were more common in males (p<0.001). No incidence of target vessel revascularization (TVR) and target lesion revascularization at one-year follow-up. Long–term mortality rates at 24-month follow-up were significantly higher in females (11% vs. 4.5 %, p <0.001). The lost-to-follow up at 24-month follow up was higher in females (13% vs. 6%, p <0.001).  

Females with STEMI undergoing primary angioplasty have higher in-hospital,30-day and long-term follow-up mortality and morbidity; probably due to smaller body habitus, older age at time of presentation, an adverse baseline cardiovascular risk profile and longer ischemic times (driven by delay in seeking help). Radial route is the preferred route, especially in females. It is associated with a reduction in vascular access site-related complications and lowering risk of venous thromboembolism, pulmonary embolism and nosocomial infection. Need for aggressive STEMI management in females cannot be overemphasized. Regular follow-up is mandated as there are higher drop-outs in females. Public health campaigns must highlight the need for all women to seek medical help promptly. General physicians should ensure that therapeutic pathways are optimized for women, especially in those with atypical symptoms.