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. 2022 Jul 4:9:863811.
doi: 10.3389/fcvm.2022.863811. eCollection 2022.

Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction

Maddalena Ardissino  1 , Adam J Nelson  2   3 , Giuseppe Maglietta  4   5 , Guidantonio Malagoli Tagliazucchi  6 , Caterina Disisto  5 , Patrizia Celli  7 , Maurizio Ferrario  8 , Umberto Canosi  8   9 , Carlo Cernetti  10 , Francesco Negri  10 , Piera Angelica Merlini  9   11 , Marco Tubaro  12 , Carlo Berzuini  13 , Chiara Manzalini  5 , Gianfranco Ignone  14 , Carlo Campana  15 , Luigi Moschini  16 , Elisabetta Ponte  17 , Roberto Pozzi  18 , Raffaela Fetiveau  19 , Silvia Buratti  5 , Elvezia Maria Paraboschi  20 , Rosanna Asselta  20 , Andrea Botti  5 , Domenico Tuttolomondo  5 , Federico Barocelli  5 , Serena Bricoli  5 , Andrea Biagi  5 , Rosario Bonura  5 , Tiziano Moccetti  21 , Antonio Crocamo  5 , Giorgio Benatti  5 , Giorgia Paoli  5 , Emilia Solinas  5 , Maria Francesca Notarangelo  5 , Elisabetta Moscarella  22 , Paolo Calabrò  22 , Stefano Duga  20 , Giulia Magnani  5 , Diego Ardissino  5   9
Affiliations

Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction

Maddalena Ardissino et al. Front Cardiovasc Med. .

Abstract

Importance: There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure.

Methods: A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1-22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).

Results: ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52-0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up.

Conclusions: There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes.

Trial registration: 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.

Keywords: baseline risk differences; gender; long term outcomes; myocardial infarction; young.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Cumulative incidence of the first primary endpoint by sex. (B) Cumulative incidence of the first secondary endpoint by sex. (C) Cumulative incidence of all primary endpoints by sex. (D) Cumulative incidence of all secondary endpoints by sex.
See this image and copyright information in PMC

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