October 19, 2023Open Access
Sex differences in ventricular arrhythmia, atrial fibrillation and atrioventricular block complicating acute myocardial infarction
Key Result
During acute myocardial infarction, women had a significantly higher risk of developing new-onset atrial fibrillation (aOR 1.27) and high-grade atrioventricular block (aOR 1.30) compared to men.
Study Design
Type
Cohort (n=14,280)
Multicenter
Yes
Structured PICO
Are there sex differences in the incidence and mortality outcomes of ventricular arrhythmias, atrial fibrillation, and atrioventricular block complicating acute myocardial infarction?
P
Population
14,280 consecutive patients with acute myocardial infarction (STEMI or NSTEMI), median age 64, 22.1% female, from the Acute Coronary Syndrome Israeli Survey (ACSIS) database (2000-2018).
I
Intervention
Female sex (assessing incidence of early/late ventricular tachyarrhythmias, atrial fibrillation, and high-grade AV block)
C
Comparator
Male sex
O
Outcome
Incidence of in-hospital arrhythmias (new-onset atrial fibrillation, high-grade AV block, or sustained ventricular tachyarrhythmias) and all-cause mortality at 30 days and 1 yearhard clinical
Women with acute myocardial infarction have a higher risk of developing atrial fibrillation and high-grade AV block compared to men, both of which are associated with increased short-term mortality.
Main Result
Effect estimate: aOR 1.27 (95% CI 1.08-1.49)
Absolute Event Rate: 8.6% vs 5%
p-value: p=0.004
Limitations
- Observational, retrospective, nonrandomized design
- Cannot exclude residual confounding
- Arrhythmias occurring out of the hospital might be under-reported
- Data on temporary or permanent pacing and antiarrhythmic medications were not systematically collected
Abstract
Background: Acute myocardial infarction (AMI) complicated by tachyarrhythmias or high-grade atrioventricular block (HAVB) may lead to increased mortality. Purpose: To evaluate the sex differences in patients with AMI complicated by tachyarrhythmias and HAVB and their associated outcomes. Materials and methods: We analyzed the incidence rates of arrhythmias following AMI from the Acute Coronary Syndrome Israeli Survey database from 2000 to 2018. We assessed the differences in arrhythmias incidence and the associated mortality risk between men and women. Results: = 0.002) remained significant in the post 30 days period. Conclusions: During AMI women experienced more AF and HAVB but fewer early VTAs than men. Early and late VTAs, AF, and HAVB were associated with increased 30-day mortality. Only late VTA and AF were associated with increased post-30-day mortality.