Key result
Female sex independently predicted an increased risk of non-fatal stroke and heart failure up to 3 years post-AMI, although long-term mortality differences disappeared after multivariate adjustment.
Why the study?
Whether sex differences exist in long-term cardiovascular outcomes after acute myocardial infarction warranted exploration to evaluate the relationships among sex, age, and long-term prognosis.
Does female sex affect long-term cardiovascular outcomes in patients with acute myocardial infarction?
Cohort (n=201,921)
Does female sex affect long-term cardiovascular outcomes in patients with acute myocardial infarction?
Following acute myocardial infarction, women have a higher independent risk of stroke and heart failure up to 3 years compared to men, despite similar long-term mortality after multivariable adjustment.
Women post-AMI may need closer stroke/HF surveillance; leaves open whether sex-specific strategies alter outcomes.
BACKGROUND: Whether a sex difference exists in long-term cardiovascular (CV) outcomes after acute myocardial infarction (AMI) is worth exploration. This study is sought to investigate the relationships among sex, age, and the long-term prognosis after AMI. METHODS: This population-based retrospective cohort study used Taiwan's National Health Insurance Research Database to investigate the sex differences in in-hospital and long-term CV outcomes in patients with AMI. We enrolled patients who were first diagnosed with AMI from January 1, 2000 to December 31, 2013. The outcomes of interest included all-cause mortality, CV death, non-fatal stroke, non-fatal heart failure, and AMI recurrence during hospitalization and 5-year follow up. The CV outcomes were also analyzed by age stratification. RESULTS: Overall, 201 921 patients with AMI were analyzed; 68.72% were men and 31.28% were women, with mean ages of 65.34 ± 14.12 and 73.05 ± 12.22 years, respectively. Major adverse cardiac events during hospitalization and up to 5 years were consistently greater in women than in men. Multivariable regression analysis revealed no sex difference existed in long-term all-cause and CV mortality. Men of all age groups consistently showed higher risk of both short- and long-term recurrence of AMI. Nonetheless, the female sex still independently predicted increased risk of non-fatal stroke and heart failure from hospitalization until 3-year follow up. CONCLUSION: Women with AMI had poorer short-term and long-term outcomes. The sex differences in long-term all-cause and CV death disappear after multivariate analysis. Nonetheless, female AMI patients independently predicted higher risk of stroke and heart failure from hospitalization until a 3-year follow-up. To better understand the pathophysiology of female patients with AMI and develop more effective management, more studies in this field are necessary in the future.
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Chang et al. (2021) conducted a cohort in acute myocardial infarction (n=201,921). Female sex vs. Male sex was evaluated on All-cause mortality, CV death, non-fatal stroke, non-fatal heart failure, and AMI recurrence during hospitalization and 5-year follow up. Female sex independently predicted an increased risk of non-fatal stroke and heart failure up to 3 years post-AMI, although long-term mortality differences disappeared after multivariate adjustment.
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