ACC Latin America 2026: Studies Reveal Sex and Regional Disparities in Heart Attack Care

Disparities in STEMI Cohort Data and Patient Demographics

The research draws on a shared cohort of 5,766 patients experiencing STEMI across the Dominican Republic, Guatemala, Mexico, Ecuador, and Bolivia. Within this participant pool, women account for just 21%, totaling 1,205 patients. According to an analysis by Marlon Miguel Espaillat, MD, and colleagues, women presenting with STEMI tend to be older than men, with a median age of 64 years compared to 60 years. Female patients also exhibit significantly higher rates of hypertension, diabetes, obesity, chronic kidney disease, and prior stroke or transient ischemic attack. Conversely, the data show that women experience lower rates of prior myocardial infarction, prior percutaneous coronary intervention, and multivessel disease. However, female patients present more frequently with atypical symptoms, Killip class III-IV severity, cardiogenic shock, and cardiac arrest upon hospital admission. Researchers also note higher rates of spontaneous coronary artery dissection and myocardial infarction with nonobstructive coronary arteries among women.

Clinical Outcomes and Adverse Composite Risks for Women

Clinical outcomes diverge sharply along sex lines following hospital admission. An analysis led by Ana M. Coeto, MD, demonstrates that women experience significantly higher rates of in-hospital death, standing at 11.6% compared to 7.1% for men. Although female sex is not independently associated with in-hospital death on its own, the research reveals it acts as an independent predictor for an adverse composite outcome of death, acute heart failure, and cardiogenic shock. This yields an odds ratio of 1.43, even after researchers adjust for stent implantation procedures. A separate focused analysis by Sara Divanne González, MD, and colleagues examines 445 patients under the age of 45, including 74 women. This younger subgroup shows that female patients still carry a higher burden of hypertension, diabetes, prior stroke, and obesity, alongside greater rates of suspected or confirmed spontaneous coronary artery dissection and lower multivessel disease prevalence. Notably, clinical presentation severity, reperfusion strategies, left ventricular ejection fraction, in-hospital mortality, and door-to-device or door-to-needle times remain comparable between young women and young men.

Geographic Clustering of Cardiometabolic Risk Factors

Geographic location plays a major role in shaping patient risk profiles across the expansive regional cohort. Among the 1,205 female patients, 100 reside in the Caribbean, 185 in Central America, 757 in Mexico, and 163 in South America. According to a study by Miguel Delgado Sr., MD, and colleagues, geographic region is strongly linked to clustered cardiometabolic risk factors. Patients in the Caribbean face the highest risk burden, with an odds ratio of 5.05 compared to patients in Mexico. Central America and South America also show elevated likelihoods of risk clustering relative to Mexico, with odds ratios of 1.86 and 1.84, respectively. Hypertension, diabetes, dyslipidemia, smoking, and prior myocardial infarction prove most prevalent in the Caribbean, where 44% of patients present with a high-risk burden.