Women who experience a myocardial infarction at a young age have worse outcomes compared with men: The mass general brigham YOUNG-MI registry

Ersilia M. DeFilippis, Bradley L. Collins, Avinainder Singh, David W. Biery, Amber Fatima, Arman Qamar, Adam N. Berman, Ankur Gupta, Mary Cawley, Malissa J. Wood, Josh Klein, Jon Hainer, Martha Gulati, Viviany R. Taqueti, Marcelo F. Di Carli, Khurram Nasir, Deepak L. Bhatt, Ron Blankstein

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)4127-4137
Number of pages11
JournalEuropean heart journal
Volume41
Issue number42
DOIs
StatePublished - Nov 7 2020

Keywords

  • Coronary angiography
  • MINOCA
  • Myocardial infarction
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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