Key result
5-alpha reductase inhibitors linked to ~20% fewer severe complications and 30-day deaths in STEMI.
Why the study?
Male sex and endogenous testosterone exacerbate neutrophilia and cardiac injury in MI, raising questions about the protective effects of androgen-modulating drugs after STEMI.
Does the use of 5-alpha reductase inhibitors or androgen deprivation therapy reduce severe complications in men with PCI-treated STEMI?
Cohort (n=40,130)
Yes
Does the use of 5-alpha reductase inhibitors or androgen deprivation therapy reduce severe complications in men with PCI-treated STEMI?
Odds Ratio: 0.8 (95% CI 0.69–0.93)
Absolute Event Rate: 20.8% vs 24.3%
Absolute Risk Reduction: 3.5%
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This result contributes to the exciting field of research into how sex hormones can affect the heart, for instance during a heart attack, but it has no direct impact on patient treatment at present.”
In men with PCI-treated STEMI, ongoing treatment with 5-alpha reductase inhibitors, but not androgen deprivation therapy, was associated with a lower risk of severe in-hospital complications and 30-day mortality.
Importance Male sex and endogenous testosterone have been shown to exacerbate neutrophilia and cardiac injury in myocardial infarction (MI), raising questions about protective actions of androgen-modulating drugs in acute ST-elevation MI (STEMI). Objective To determine whether the use of 5-alpha reductase inhibitors (5αRIs) or androgen deprivation therapy (ADT), drugs that lower androgen actions, is associated with a reduced frequency of severe complications after percutaneous coronary intervention (PCI)–treated STEMI in men. Design, Setting, and Participants Nationwide, registry-based cohort study of men aged 35 to 84 years with first-time STEMI treated with PCI from January 2006 to December 2022 in Sweden. Propensity score matching was used to match men treated with 5αRIs or ADT with untreated control patients. The primary outcome was a composite of mortality within 30 days and severe in-hospital complications. Data were analyzed in June 2026. Main Outcomes and Measures The primary outcome was a composite of mortality within 30 days and severe in-hospital complications (any of: cardiac arrest and resucitatation, atrioventricular block stage II or III, cardiogenic schock, new-onset atrial fibrillation or flutter, severely depressed left ventricular function, or mechanical complication). Odds ratios were calculated using conditional logistic regression. Results In this study of men with PCI-treated STEMI, 1305 men treated with 5αRI (mean [SD] age, 74.2 [6.7] years) were matched to 6463 control patients, and 358 men treated with ADT (mean [SD] age, 76.2 [6.2] years) were matched to 1774 control patients. The odds of experiencing a severe complication were lower in men treated with 5αRIs (odds ratio [OR], 0.80; 95% CI, 0.69-0.93). No significant association was observed for men treated with ADT compared with their matched control patients (OR, 1.10; 95% CI, 0.83-1.45). Conclusions and Relevance In this cohort study of men with PCI-treated STEMI, use of 5αRI but not ADT was associated with a lower risk of severe complications. These results warrant further research into the role of androgens and drugs that affect androgen levels in the acute phase of STEMI.
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Colldén et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=40,130). 5-alpha reductase inhibitors (5αRIs) vs. Unexposed matched control patients was evaluated on Composite of mortality within 30 days and severe in-hospital complications (OR 0.80, 95% CI 0.69-0.93). In men with PCI-treated STEMI, ongoing exposure to 5-alpha reductase inhibitors was associated with a lower risk of severe in-hospital complications and 30-day mortality compared to matched controls (OR 0.80).
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