Sex differences in coronary artery lesions and in‐hospital outcomes for patients with ST‐segment elevation myocardial infarction under the age of 45

Abstract

Objective: We aimed to compare baseline characteristics, coronary angiogram findings, and in-hospital outcomes between female and male patients with ST-segment elevation myocardial infarction (STEMI) under the age of 45 years. Background: Although sex differences in risk factor profile have been documented for young patients with STEMI, limited data exist on the prevalence of spontaneous coronary artery dissection in these patients. Methods: As part of an ongoing hospital-based registry of suspected STEMI, we analyzed the original data for 51 women under the age of 45 years matched with 93 men of similar age who underwent coronary angiography at two percutaneous coronary intervention centers, between January 2003 and December 2012. Two interventional cardiologists independently reviewed coronary angiograms for all patients. Results: The mean age for all patients was 39 years (range, 24-44) and the overall prevalence of cigarette smoking, dyslipidemia, hypertension, and diabetes mellitus were 70, 32, 13, and 4%, respectively. Young women were more likely to present with spontaneous coronary artery dissection (22 vs. 3%, p = .003) and more of them experienced reinfarction during the hospital course (15 vs. 1%, p = .01). The inhospital mortality rate was 2% for both sexes. Conclusions: Spontaneous coronary artery dissection is an important cause of myocardial infarction in young female adults, accounting for 22% (95% confidence interval, 11-35%) of women with STEMI under the age of 45 years. The true prevalence of spontaneous coronary artery dissection might even be underestimated, because of the limited availability of advanced imaging techniques at the time of our study.

STEMI in young women: Don't miss spontaneous coronary artery dissection!

“…In the largest series of SCAD patients presenting with STEMI, the prevalence of SCAD in women less than 50 years old was 19%. 3 In this issue of Catherization and Cardiovascular Interventions, Vautrin et al 4 The most striking finding was that among these young patients presenting with STEMI, the prevalence of SCAD was significantly higher in women compared to men (22 vs. 3%) consistent with other studies. Among women the majority of SCAD cases were Type 2 SCAD and the left anterior descending artery was the most affected vessel consistent with prior studies.…”

“…In this issue of Catherization and Cardiovascular Interventions , Vautrin et al 4 examined the differences in women versus men presenting with STEMI under the age of 45 among 489 patients (including 57 women, 11.6% of the total) who presented at two percutanous coronary intervention (PCI) centers in Northern France. A total of 51 women and 93 men matched 1:2 by age, year of admission, and catherization lab were included in the analysis.…”

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

“…SCAD is known to be an underdiagnosed and important cause of MI especially in young women [ 36 ]. An interesting study with a small cohort found that SCAD accounted for 22% of women with STEMI under the age of 45 [ 37 ]. In general, and as performed in our cohort (86%), conservative management is preferred to revascularization [ 36 ].…”

Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40

“…It is thought that the greatest reason for this discrepancy may be due to the different age limit of the patients included in the study and the inclusion of both STEMI and NSTEMI patient groups in most studies. 14,[18][19][20][21][22] Given the symptoms, the most common complaint of patients (95.5%) was typical chest pain. Although; typical chest pain was not statistically significant, it tended to be more common in men, while shortness of breath was significantly higher in women.…”