Key result
In a matched pair analysis of patients with acute myocardial infarction, infarct size did not differ significantly between women and men (13.5 vs. 15.1, p=0.32), though microvascular obstruction was smaller in women.
Why the study?
Are there gender differences in CMR infarct characteristics (scar size and microvascular obstruction) in patients after acute myocardial infarction?
Observational (n=448)
No
Are there gender differences in CMR infarct characteristics (scar size and microvascular obstruction) in patients after acute myocardial infarction?
Women have significantly smaller microvascular obstruction sizes compared to men after acute myocardial infarction despite similar infarct sizes, which may reflect better cardioprotective mechanisms.
Besides different risk profiles for cardiovascular events in men and women, several studies reported gender differences in mortality after acute myocardial infarction (AMI). As infarct size has been shown to closely correlate with mortality, it is widely accepted as surrogate marker for clinical outcome. Currently, cardiovascular imaging studies covering the issue of gender differences are rare. As magnetic resonance scar characterization parameters are emerging as additional prognostic factors after acute myocardial infarction, we sought to evaluate gender differences in CMR infarct characteristics in patients after acute myocardial infarction. We prospectively analyzed patients (n=448) with AMI and primary angioplasty, who underwent contrast enhanced MRI imaging on a 1.5 T scanner in median 5 [3.8;5.6] days after the acute event. MRI scar size was measured 15 minutes after gadolinium injection. In addition presence and extent of MVO was assessed. A matched pair analysis was performed in order to exclude confounding by gender related co-morbidities and gender differences in established clinical risk factors. Matching process according to clinical risk defined by GRACE score resulted in 93 mixed gender couples. Women were significantly older than men (64.4±11.9 vs. 60.5±12.3, p= 0.03) and presented with a significantly better ejection fraction before angioplasty (48.9±8.4 vs. 46.2±8.9, p=0.04). Infarct size did not differ significantly between women and men (13.5±10.7 vs. 15.1±11.8, p=0.32). Size of microvascular was significantly smaller in women than in men (0.48+-1.3 vs. 1.2+-3.0, p=0.03). Comparing scar characterization between women and men with similar risk profile revealed no gender differences in scar size. Size of MVO, however, was significantly smaller in women and might reflect better cardioprotective mechanisms in women. Whether these changes have prognostic implications has to be tested on a larger patient population.
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Langhans et al. (2012) conducted an observational in Acute myocardial infarction (n=448). Female gender vs. Male gender was evaluated on Infarct size (p=0.32). In a matched pair analysis of patients with acute myocardial infarction, infarct size did not differ significantly between women and men (13.5 vs. 15.1, p=0.32), though microvascular obstruction was smaller in women.
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