Impact of sex differences on revascularization and long-term clinical outcomes in patients with non-ST-elevation myocardial infarction: a multicentre study from China

The influence of sex differences on the clinical prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI) remains controversial. This multicenter, retrospective study analyzed NSTEMI patients from five institutions. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major adverse cardiac events (MACE). Multivariate logistic regression was used to assess sex differences in revascularization. Multivariate Cox regression with stepwise selection identified independent prognostic predictors. Stratified analyses were performed by revascularization status. To strengthen the analytical robustness, propensity score matching (PSM) was employed as a sensitivity analysis, balancing age, comorbidities, and key treatment factors. A total of 4,911 NSTEMI patients (3,506 men; 1,405 women) completed follow-up. Women were less likely to undergo revascularization (adjusted odds ratio 0.68, 95%CI 0.58–0.79). Over a median follow-up of 527 days, women had significantly lower cumulative survival free from MACCE and MACE (both P < 0.001). After multivariate adjustment, women remained to have an increased risk of MACCE (HR 1.20, 95% CI 1.03–1.40) and MACE (HR 1.30, 95% CI 1.09–1.55) in the overall cohort, particularly among those not undergoing revascularization (MACCE: HR 1.30, 95% CI 1.05–1.60; MACE: HR 1.64, 95% CI 1.27–2.10). However, no significant sex-based differences were observed in the revascularized subgroup (P > 0.05). These findings were consistent in the PSM-based sensitivity analysis. The sex-based prognosis difference in NSTEMI is linked to underutilization of revascularization in women. Ensuring equitable guideline-directed revascularization may eliminate this disparity.