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Comparative Study
. 2025 Jun 3;32(8):696-707.
doi: 10.1093/eurjpc/zwae333.

Sex differences in myocardial infarction care and outcomes: a longitudinal Scottish National Data-Linkage Study

Tiberiu A Pana  1   2 , Mamas A Mamas  3 , Phyo K Myint  1   2 , Dana K Dawson  2
Affiliations
Comparative Study

Sex differences in myocardial infarction care and outcomes: a longitudinal Scottish National Data-Linkage Study

Tiberiu A Pana et al. Eur J Prev Cardiol. .

Abstract

Aims: We investigate sex disparities in management and outcomes of myocardial infarction (MI) in contemporary practice in Scotland.

Methods and results: This was a longitudinal cohort study including all MI admissions aged 45-80 years across Scotland between 2010-2016 and 2:1 age, sex, and general practice-matched general population controls. Participants were followed up until the end of 2021. We analysed in-hospital outcomes (percutaneous coronary intervention, secondary prevention and mortality) using Poisson regressions, adjusting for age, comorbidities, and ST-elevation. We used Royston-Parmar models for long-term outcomes (all-cause and cardiovascular mortality, incident cardiovascular events), adjusting for age, comorbidities, and secondary prevention. Of a total 47 063 MI patients, 15 776 (33.5%) were women. Median (inter-quartile range) age was 66 (57, 73) years. Compared to men, women were older and more comorbid, but were less likely to undergo percutaneous coronary intervention [risk ratio (95% confidence interval) - 0.87 (0.86 - 0.89)] or receive secondary prevention at discharge [0.94 (0.93-0.95)]. No in-hospital mortality difference was observed between sexes [1.06 (0.99-1.13) after adjustment]. Over a median follow-up of 8.2 (6.7, 10.1) years, women had higher crude rates of adverse outcomes. After full adjustment, this translated into a lower risk for women compared to men of all-cause mortality [hazard ratio, 0.92 (0.89-0.95)], cardiovascular mortality [0.82 (0.78-0.87)], and cardiovascular events [0.92 (0.88-0.95)]. The female survival advantage seen in general population controls was attenuated in MI patients.

Conclusion: Women were undertreated compared to men after MI. Their survival and outcome benefits may be improved further. Poor outcomes in men despite better receipt of secondary prevention require further attention.

Keywords: Cardiovascular; Mortality; Myocardial infarction; Outcomes; Scotland; Sex.

Plain language summary

We investigated sex disparities in care and outcomes across Scotland amongst men and women admitted for heart attacks. We included all 15 776 women and 31 287 men admitted to hospitals across Scotland between 2010 and 2016, who were followed up until the end of 2021. We analysed their outcomes both in the hospital and over an average follow-up of 8 years after hospital discharge. We also compared them to 81 341 matched healthy people without heart disease. Compared to men, women were older and had more long-term conditions. Women were also less likely to undergo evidence-based treatment for heart attacks. After controlling for other factors, there were no differences between sexes in terms of in-hospital death. Analyses of the long-term follow-up revealed that women were significantly less likely than men to be prescribed treatments aiming to prevent further heart disease or death. Despite this, women had an 8% lower risk of death and an 18% lower risk of dying from heart disease compared to men. Comparisons with the matched healthy population revealed that this ‘female survival advantage’ was less pronounced in people with heart attacks. This suggests that the long-term outcomes of women after heart attacks may be improved further. We also noted that the outcomes in men remain poor despite better treatment, which also requires further attention.

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Conflict of interest statement

Conflict of interest: none declared.

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