Sex differences in treatment and outcomes amongst myocardial infarction patients presenting with and without obstructive coronary arteries: a prospective multicentre study

Abstract

Background Women have an increased prevalence of myocardial infarction (MI) and non-obstructive coronary arteries (MINOCA). Whether sex differences exist in the outcomes of patients with MI and obstructive coronary arteries (MIOCA) vs MINOCA remains unclear. We describe sex-based differences in diagnosis, treatment, and clinical outcomes of patients with MINOCA versus MIOCA. Methods A large-scale cohort study of patients with ST/non-ST elevation MI undergoing coronary angiography (01/2015-12/2019). Patient demographics, diagnosis, prescribed discharge medications, in-hospital complications, and follow-up data were prospectively collected. Results 13,202 participants were included (males 68.2%, females 31.8%). 10.9% were diagnosed with MINOCA. Median follow up was 4.62 years. Females (44.8%) were as commonly diagnosed with MINOCA as males (55.2%), unlike the male preponderance in MIOCA (male: 69.8%, female: 30.2%). Less secondary-prevention medications were prescribed at discharge for MINOCA than MIOCA. There was no difference in mortality risk between MINOCA and MIOCA (In-hospital: adjusted odds ratio (OR) 1.32, 95% confidence interval (CI) 0.74-2.35, p = 0.350; long-term: adjusted hazard ratio (HR) 1.03, 95%CI 0.81-1.31, p = 0.813). MINOCA patients had reduced mortality at long-term follow up if prescribed secondary-prevention medications (aHR 0.64, 95%CI 0.47-0.87, p = 0.004). Females diagnosed with MIOCA had greater odds of in-hospital and one-year mortality than males (aOR 1.50, 95%CI 1.09-2.07, p = 0.014; aHR 1.18, 95%CI 1.01-1.38, p = 0.048). Conclusion MINOCA patients have similar mortality rates as MIOCA patients. MINOCA patients were less likely than those with MIOCA to be discharged with guideline-recommended secondary-prevention therapy, however those with MINOCA who received secondary-prevention survived longer. Females with MIOCA experienced higher mortality rates versus males.

Do Chest Pain Characteristics in Patients with Acute Myocardial Infarction Differ between Those with and without Obstructive Coronary Artery Disease?

“…(Table 1). Fewer secondary cardioprotective therapies and cardiac rehabilitation program referrals were provided to MINOCA patients compared to MICAD, similar to previous studies [16,17]. This may be explained by the lack of a consensus strategy for treatment of MINOCA due to the lack of prospectively designed randomised therapeutic clinical trials; hence, guidelines are based on observational studies and expert opinion [13].…”

Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020

“… 42 , 43 , 44 , 45 , 46 , 47 Women also have a higher prevalence of myocardial infarction with nonobstructive coronary artery disease, and while patients with myocardial infarction with nonobstructive coronary artery disease have a similar mortality rate compared with AMI with obstructive coronaries, myocardial infarction with nonobstructive coronary artery disease is still often presumed to be benign and is less aggressively treated with secondary preventive therapies, potentially contributing to the increase in the mortality risk in women. 48 In the United States, the in‐hospital mortality has been demonstrated to be higher in women than in men with ST‐segment–elevation myocardial infarction (STEMI), but the outcomes for non–ST‐segment–elevation myocardial infarction has not shown a difference based on sex. 49 , 50 , 51 , 52 , 53 , 54 , 55 For patients with STEMI, the rates of angiography and coronary interventions are less for women and women are more likely to experience longer door‐to‐balloon time than men.…”

Differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years following acute coronary syndromes: a prospective multicentre study

“…The database, variables and methods of analysis used in this study have been presented previously by our research group. 13 …”

“…The database, variables and methods of analysis used in this study have been presented previously by our research group. 13 Study design, setting and participants This is a cohort study of patients between 1 January 2015 and 31 December 2019 with a presenting diagnosis of STEMI and NSTEMI and unstable angina that underwent invasive coronary angiography at a high-volume cardiac centre; the Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, UK. The Freeman Hospital receives patients referred from six district hospitals covering a population of 2 million with an annual percutaneous coronary intervention (PCI) procedure volume of ~3000 cases (60%-65% ACS cases).…”