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Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS - UEFISCDI BACKGROUND Women with ST-segment elevation myocardial infarction (STEMI) have been shown to present higher in-hospital mortality compared to their male counterparts. However, most of these data were obtained in the pre-percutaneous coronary intervention (PCI) or even in the pre-thrombolytic era. PURPOSE We aimed to investigate the contribution of female gender to the occurrence of in-hospital complications in STEMI patients treated by primary PCI. METHODS Data regarding in-hospital outcomes (i.e., mortality, inotropic and diuretic drugs usage, occurrence of cardiogenic shock, cardiac arrest) were evaluated in 848 consecutive patients treated by primary PCI for STEMI. Occurrence of new-onset kidney dysfunction and length of hospital stay were also analysed. The relationship between gender and the occurrence of STEMI-related complications was evaluated. RESULTS Out of the 848 patients included in the study, 254 (29.9%) were women. Compared to their male counterparts, female STEMI patients were older (65.7 ± 11.3 vs. 60.1 ± 11.8 years; p&amp;lt; 0.0001), had more often pre-existing heart failure, hypertension, diabetes mellitus, and chronic kidney disease (all p&amp;lt; 0.05), longer symptom onset-to-cardiac catheterization laboratory time intervals (7.9 ± 6.7 vs. 6.4 ± 5.0 h; p&amp;lt; 0.001), and higher Killip class on admission (p = 0.02). Cardiogenic shock, inotropic and diuretic drugs usage, kidney dysfunction, and cardiac arrest occurred more often in female than in male patients (all p&amp;lt; 0.01). The length of hospital stay (p&amp;lt; 0.01) and in-hospital death (RR 1.89 [95%CI 1.43-2.50], p&amp;lt; 0.001) were also higher in female compared to male patients, whereas renin-angiotensin-aldosterone system (RAAS) blockers were used more rarely in female patients (p = 0.01). When corrected for potential confounders, female gender remained an independent predictor of in-hospital mortality (p = 0.01). However, when in-hospital RAAS blockers usage was included in the model, female gender was no longer associated with increased in-hospital mortality (p = 0.15). CONCLUSIONS Female patients with STEMI continue to display significantly higher in-hospital mortality rates compared to their male peers including in the primary PCI era. The difference in in-hospital mortality between female and male patients with STEMI could be at least partially due to the significantly lower usage of RAAS blockers in women. Increasing in-hospital RAAS blockers usage in female patients with STEMI may improve survival in this high-risk population.

Renin-angiotensin-aldosterone system blockers could contribute to the gender-related disparities in STEMI outcomes