Acute myocardial infarction in the young - National Trend Analysis with gender-based difference in outcomes

Bandyopadhyay, Dhrubajyoti; Chakraborty, Sanjoy; Amgai, Birendra; Patel, Neelkumar; Hajra, Adrija; Heise, Lyndsey; Sud, Karan; Ghosh, Raktim; Herzog, Eyal; Aronow, Wilbert S.; Fonarow, Gregg C.; Lavie, Carl J.

doi:10.1016/j.ijcard.2019.11.096

Cited by 25 publications

(16 citation statements)

References 45 publications

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“…Further, women were considered to represent a distinct, high-risk CAD population with a higher prevalence of traditional and non-traditional cardiovascular risk factors [23]. In our cohort of premature STEMI, all cardiovascular risk factors but diabetes were present in the same proportion in both sexes.…”

Section: Discussionmentioning

confidence: 98%

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Lorca

Pascual

Aparicio

et al. 2021

JCM

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Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

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Section: Discussionmentioning

confidence: 98%

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Lorca

Pascual

Aparicio

et al. 2021

JCM

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“…Over the past decade, studies have reported conflicting results on sex differences in clinical profiles and outcomes in patients with AMI. Generally, women are reported to be older, have more comorbidities and have lower rates of receiving PCI and evidence-based treatment than men (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The unadjusted in-hospital and long-term mortality in women tend to be higher than in men, and this difference is more pronounced in STEMI subpopulation (3)(4)(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

“…The sex differences in clinical presentation, treatment and outcomes of patients with acute myocardial infarction (AMI) have been investigated for decades (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Generally, women with AMI have a greater burden of comorbidity and atypical symptoms than men.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies report a higher unadjusted mortality for women after AMI, which is mainly explained by differences in age, comorbidities and use of guideline-based treatment (3)(4)(5)(6)(7). Meanwhile, others claim that the adjusted rates of mortality and cardiovascular (CV) events for men and women are similar, suggesting that both sexes can benefit from the current developed therapies (8)(9)(10)(11). Even though these research enrolled a large sample of AMI, few studies have focused on the patients with myocardial infarction with non-obstructive coronary arteries (MINOCA).…”

Section: Introductionmentioning

confidence: 99%

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Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Gao

Wahab

Huang

et al. 2021

Front. Cardiovasc. Med.

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Background: Sex differences in clinical profiles and prognosis after acute myocardial infarction have been addressed for decades. However, the sex-based disparities among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remain largely unreported. Here, we investigated sex-specific characteristics and long-term outcomes in MINOCA population.Methods: A total of 1,179 MINOCA patients were enrolled, including 867 men and 312 women. The mean follow-up was 41.7 months. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal reinfarction, revascularization, non-fatal stroke, and hospitalization for unstable angina or heart failure. Baseline data and outcomes were compared. Kaplan-Meier curves and Cox regression analyses were used to identify association between sex and prognosis.Results: Female patients with MINOCA had more risk profiles with regard to older age and higher prevalence of hypertension and diabetes compared with men. The evidence-based medical treatment was similar in men and women. The incidence of MACE (men vs. women: 13.8 vs. 15.3%, p = 0.504) did not differ significantly between the sexes. The Kaplan-Meier analysis also indicated that women had a similar incidence of MACE compared to men (log rank p = 0.385). After multivariate adjustment, female sex was not associated with the risk of MACE in overall (adjusted hazard ratio 1.02, 95% confidence interval: 0.72–1.44, p = 0.916) and in subgroups of MINOCA patients.Conclusion: The long-term outcomes were similar for men and women presenting with MINOCA despite older age and more comorbidities in women. Future research should aim to improve in-hospital and post-discharge care for both sexes with MINOCA.

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“…1,2 Recent findings have shown no difference in all-cause in-hospital mortality between young men and women. 10 Although early mortality rate is low, additional ischemic events may occur in the future. 3 In the 20-year cohort study, 3 AMI was the most frequent new major acute cardiovascular event (MACE) (2.6 per 100 patient-years).…”

Section: Discussionmentioning

confidence: 99%

Acute Coronary Disease in very Young Patient: A Reality!

Nascimento¹,

Mello²,

Cunha³

et al. 2020

International Journal of Cardiovascular Sciences

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Acute myocardial infarction in the young - National Trend Analysis with gender-based difference in outcomes

Cited by 25 publications

References 45 publications

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Acute Coronary Disease in very Young Patient: A Reality!

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