Background: Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence.

Objective: To determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany.

Design and Patients: From the AOK (Allgemeine Ortskrankenkasse) health insurance, 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017.

Key Results: Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p <0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs 6.6%), longer hospitalizations (12.2 vs 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%).

After adjustment for patient’s risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00-1.04; p=0.036). Notably men, more received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p<0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50–0.55; men HR 0.48, 95% CI 0.47 – 0.50, p^int=0.014).

Conclusion: In a recent nationwide analysis, women with STEMI were older, had more comorbidities, were less likely to undergo revascularization, and were at increased risk of severe complications and reduced overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival.