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Comparative Study
. 2021 Sep;107(18):1480-1486.
doi: 10.1136/heartjnl-2021-319118. Epub 2021 Apr 20.

Sex differences in investigations and outcomes among patients with type 2 myocardial infarction

Dorien M Kimenai  1 , Bertil Lindahl  2   3 , Andrew R Chapman  4 , Tomasz Baron  3 , Anton Gard  3 , Ryan Wereski  4 , Steven J R Meex  5   6 , Tomas Jernberg  7 , Nicholas L Mills  8   4 , Kai M Eggers  3
Affiliations
Comparative Study

Sex differences in investigations and outcomes among patients with type 2 myocardial infarction

Dorien M Kimenai et al. Heart. 2021 Sep.

Abstract

Objectives: Type 2 myocardial infarction (MI) is a heterogenous condition and whether there are differences between women and men is unknown. We evaluated sex differences in clinical characteristics, investigations and outcomes in patients with type 2 MI.

Methods: In the Swedish Web based system for Enhancement and Development of Evidence based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we compared patients admitted to coronary care units with a diagnosis of type 1 or type 2 MI. Sex-stratified Cox regression models evaluated the association with all-cause death in men and women separately.

Results: We included 57 264 (median age 73 years, 65% men) and 6485 (median age 78 years, 50% men) patients with type 1 and type 2 MI, respectively. No differences were observed in the proportion of men and women with type 2 MI who underwent echocardiography and coronary angiography, but women were less likely than men to have left ventricular (LV) impairment and obstructive coronary artery disease (CAD). Compared with type 1 MI, patients with type 2 MI had higher risk of death regardless of sex (men: adjusted HR 1.55 (95% CI 1.44 to 1.67); women: adjusted HR 1.34 (95% CI 1.24 to 1.45)). In those with type 2 MI, the risk of death was lower for women than men (adjusted HR 0.85 (95% CI 0.76 to 0.92) (men, reference)).

Conclusions: Type 2 MI occurred in men and women equally and we found no evidence of sex bias in the selection of patients for cardiac investigations. Patients with type 2 MI had worse outcomes, but women were less likely to have obstructive CAD or severe LV impairment and were more likely to survive than men.

Keywords: acute coronary syndrome; myocardial infarction; risk factors.

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Conflict of interest statement

Competing interests: SJRM received research funding and lecture fees from Abbott Laboratories and Roche Diagnostics. NLM reports research grants awarded to the University of Edinburgh from Abbott Diagnostics and Siemens Healthineers outside the submitted work, and honoraria from Abbott Diagnostics, Siemens Healthineers, Roche Diagnostics and LumiraDx. The other authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Crude cumulative occurrence of all-cause death in patients with type 1 and type 2 myocardial infarction (MI), stratified by sex.
Figure 2
Figure 2
Crude cumulative occurrence of major adverse cardiovascular events (MACE) in patients with type 1 and type 2 myocardial infarction (MI), stratified by sex. MACE is defined as a composite end point of all-cause mortality, readmissions for non-fatal MI, heart failure and ischaemic stroke.
Figure 3
Figure 3
Sex-specific incidence rates (and their 95% CIs) per 1000 person-years of all-cause death (panel A) and major adverse cardiovascular events (MACE) (panel B) for patients with type 1 and type 2 myocardial infarction (MI). MACE is defined as a composite end point of all-cause mortality, readmissions for non-fatal MI, heart failure and ischaemic stroke.
See this image and copyright information in PMC

Comment in

References

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