November 27, 2024European Journal of Preventive Cardiology11 citationsOpen Access
View Full PaperSex differences in myocardial infarction care and outcomes: a longitudinal Scottish National Data-Linkage Study
Key Result
Women with myocardial infarction had a lower risk of long-term all-cause mortality compared to men (HR 0.92; 95% CI 0.89-0.95), despite being less likely to receive invasive management.
Study Design
Type
Cohort (n=47,063)
Multicenter
Yes
Structured PICO
Are there sex disparities in the management and outcomes of myocardial infarction?
P
Population
47,063 patients aged 45-80 years admitted with myocardial infarction in Scotland, followed for a median of 8.2 years.
E
Exposure
Female sex
C
Comparator
Male sex
O
Outcome
In-hospital outcomes (percutaneous coronary intervention, secondary prevention, and mortality) and long-term outcomes (all-cause mortality, cardiovascular mortality, and incident cardiovascular events)hard clinical
Despite being undertreated with PCI and secondary prevention compared to men, women with MI had lower adjusted long-term all-cause and cardiovascular mortality.
Main Result
Hazard Ratio: 0.92 (95% CI 0.89–0.95)
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.