TY - JOUR
T1 - Women who experience a myocardial infarction at a young age have worse outcomes compared with men
T2 - The mass general brigham YOUNG-MI registry
AU - DeFilippis, Ersilia M.
AU - Collins, Bradley L.
AU - Singh, Avinainder
AU - Biery, David W.
AU - Fatima, Amber
AU - Qamar, Arman
AU - Berman, Adam N.
AU - Gupta, Ankur
AU - Cawley, Mary
AU - Wood, Malissa J.
AU - Klein, Josh
AU - Hainer, Jon
AU - Gulati, Martha
AU - Taqueti, Viviany R.
AU - Di Carli, Marcelo F.
AU - Nasir, Khurram
AU - Bhatt, Deepak L.
AU - Blankstein, Ron
N1 - Publisher Copyright:
Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2020.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2020/11/7
Y1 - 2020/11/7
N2 - Aims There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age. ................................................................................................................................................................................................... Methods Consecutive patients presenting to two large academic medical centres with a Type 1 MI at <_50 years of age be- and results tween 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61).Conclusions Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.
AB - Aims There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age. ................................................................................................................................................................................................... Methods Consecutive patients presenting to two large academic medical centres with a Type 1 MI at <_50 years of age be- and results tween 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61).Conclusions Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.
KW - Coronary angiography
KW - MINOCA
KW - Myocardial infarction
KW - Women
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U2 - 10.1093/eurheartj/ehaa662
DO - 10.1093/eurheartj/ehaa662
M3 - Article
C2 - 33049774
AN - SCOPUS:85094917651
VL - 41
SP - 4127
EP - 4137
JO - European heart journal
JF - European heart journal
SN - 0195-668X
IS - 42
ER -