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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. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. 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, more men 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). In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival. [Display omitted] • Compared to men, women with STEMI were older and had more comorbidities. • Women had higher rates of inpatient complications, received percutaneous coronary intervention less often, and when adjusted for the risk profile, the female sex was associated with reduced overall survival. • After STEMI, women received all four guideline-recommended drugs less often, although the prognosis improved with the increase in these drugs. [ABSTRACT FROM AUTHOR]

Simple Summary: Acute myocardial infarction (AMI) and cancer are common and serious diseases. As the prognosis and treatment of both diseases have improved, more cancer patients will also suffer an AMI. We examined anonymized data from the largest German public health insurance company of over 175,000 patients hospitalized for ST elevation myocardial infarction (STEMI) between 2010 and 2017 with a follow up until 2018. Of these STEMI patients, 15.5% had pre-existing cancer. The most common cancers, in descending order, were skin, prostate, colon, breast, urinary tract, and lung cancers. What is special about STEMI patients with malignant diseases—they were older, suffered more frequently from three-vessel coronary diseases, had more frequent atrial arrhythmias, chronic kidney disease, chronic heart failure, cerebrovascular disease, and peripheral arterial occlusive disease (PAD). They were more likely to have had previous AMIs, previous percutaneous coronary interventions (PCI), heart surgery, and strokes. Despite these comorbidities, acute PCI was used only 2–6% less often than in patients without cancer. Cancer adverse events were more common in the hospital. The eight-year survival rate was 57.3 without cancer and ranged from 41.2% to 19.2% with different cancers. Advanced stage of PAD, lung cancer, existing metastasis, and a previous stroke had the greatest impact on all-cause mortality. Background: Acute myocardial infarction (AMI) and cancer are common and serious diseases. As the prognosis and treatment of both diseases has improved, more cancer patients will suffer an AMI. Unfortunately, data on these "double hit" patients is scarce. Methods: From the largest public German health insurance, anonymized data of all patients with pre-existing cancer who were hospitalized due to ST-elevation MI (STEMI) between 2010 and 2017 were analyzed and followed-up until 2018. Results: Of 175,262 STEMI patients, 27,213 had pre-existing cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older and presented more often with coronary three-vessel disease, atrial arrhythmias, chronic kidney disease, chronic heart failure, cerebrovascular and peripheral artery disease (PAD, each p < 0.001). They showed more often previous AMI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p < 0.001). Acute PCIs were applied between 2 and 6% less frequently compared to those without cancer. In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0–57.7%) without cancer and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for all-cause mortality found, e.g., lung cancer (HR 2.04), PAD stage 4–6 (HR 1.78), metastasis (HR 1.72), and previous stroke (HR 1.44) to have the strongest impact (all p < 0.001). Conclusion: In this large "real world" data, prognosis after STEMI in cancer patients was markedly reduced but differed widely between cancer types. Of note, no withholding of interventional treatments in cancer patients could be observed. [ABSTRACT FROM AUTHOR]