Sex-based differences in presentation, treatment, and complications among middle-aged and older adults hospitalized for acute myocardial infarction: a cross-sectional study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute myocardial infarction (AMI) (n=1312). Intervention: Female sex vs. Male sex. Primary outcome: In-hospital mortality (OR 1.16, 95% CI 0.70-1.91, p=0.560).

Q: What does this research mean for the field?

Although women hospitalized for acute myocardial infarction present with higher clinical risk, more frequent atypical symptoms, and a higher proportion of NSTEMI compared to men, in-hospital mortality does not differ significantly between sexes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Zain Islam Arain; Abdul Ghaffar Memon; Shahid Hussain Memon; Mohammad Taha Mustafa Shaikh; Nandlal Rathi; Feroz Memon⁴; Muhammad Zaman Baloch; Shaheer Zafar

doi:10.21203/rs.3.rs-11205922/v1

November 11, 2026Open Access

Sex-based differences in presentation, treatment, and complications among middle-aged and older adults hospitalized for acute myocardial infarction: a cross-sectional study

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Why the study?

Sex-related differences in AMI may involve clinical presentation, infarction phenotype, treatment, and short-term outcomes, with potential variation across age groups, motivating an evaluation among middle-aged and older hospitalized patients.

Does female sex compared to male sex affect clinical presentation, infarction subtype, treatment patterns, and in-hospital mortality among middle-aged and older adults hospitalized for acute myocardial infarction?

Key Points

To evaluate sex-based differences in clinical presentation, infarction subtype, clinical risk profile, treatment patterns, and in-hospital outcomes among middle-aged and older patients hospitalized with acute myocardial infarction.
Hospital-based observational study of 1,312 patients (409 women [31.2%] and 903 men [68.8%]) aged ≥45 years admitted with acute myocardial infarction between 4 May 2021 and 3 January 2024 in Pakistan.
Cohort was stratified into middle-aged (45–64 years, n=999) and older (65–85 years, n=313) groups; patients with prior myocardial infarction, cardiomyopathy, bypass surgery, or chronic renal disease were excluded.
Evaluated presenting symptoms, Killip class, GRACE and TIMI risk scores, pharmacotherapy, revascularization, and in-hospital mortality using bivariate tests and multivariable logistic regression.
Non-ST-segment elevation myocardial infarction was more frequent among women than men (86.8% vs. 56.0%; OR 5.16, 95% CI 3.76–7.07; P < 0.001), whereas primary chest pain and ST-segment elevation myocardial infarction were more common in men.
Women more frequently presented with higher Killip classes (P < 0.001), higher GRACE scores, and lower eGFR, while primary percutaneous coronary intervention for ST-segment elevation myocardial infarction was documented more frequently among men.
In-hospital mortality showed no statistically significant difference between women and men (6.1% vs. 5.3%; OR 1.16, 95% CI 0.70–1.91; P = 0.560).

Study Design

Type

Cross-Sectional (n=1,312)

Multicenter

No

Structured PICO

Does female sex compared to male sex affect clinical presentation, infarction subtype, treatment patterns, and in-hospital mortality among middle-aged and older adults hospitalized for acute myocardial infarction?

P

Population

1,312 middle-aged and older adults (aged 45-85 years, 31.2% female) hospitalized with new-onset acute myocardial infarction in Pakistan, excluding those with prior MI or CABG, evaluated during index admission.

E

Exposure

Female sex (n=409)

C

Comparator

Male sex (n=903)

O

Outcome

In-hospital mortality and post-MI complications (discharge without documented post-MI complication, discharge with post-MI complication, or in-hospital death), as well as clinical presentation, AMI subtype, Killip class, risk scores, and treatment patterns during index hospitalizationhard clinical

Main Result

Odds Ratio: 1.16 (95% CI 0.7–1.91)

Absolute Event Rate: 6.1% vs 5.3%

p-value: p=0.560

Limitations

Observational, single-center design limits generalizability and precludes causal inference
Residual confounding from unmeasured factors cannot be excluded
Available analysis did not include adjusted regression modelling or imputation-based missing-data analysis, so findings are unadjusted
Assessed only in-hospital outcomes without evaluating longer-term mortality, recurrent infarction, or subsequent cardiovascular events
Observational study design cannot establish whether sex independently determined treatment selection
Treatment selection may reflect unmeasured differences in infarction type, clinical risk, contraindications, and presentation characteristics not fully captured by the analysis

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Implication

In a Pakistani cohort of middle-aged and older adults hospitalized with AMI, women presented more frequently with NSTEMI, non-chest pain symptoms, higher Killip classes, and lower rates of primary PCI than men, but experienced no significant difference in in-hospital mortality.

Abstract

Background Sex-related differences in acute myocardial infarction (AMI) may involve clinical presentation, infarction phenotype, treatment, and short-term outcomes, with potential variation across age groups. This study evaluated sex-based differences among middle-aged and older patients hospitalized with AMI. Methods This observational study included 1,312 patients hospitalized with AMI between 4 May 2021 and 3 January 2024. Demographic characteristics, presenting symptoms, AMI subtype, Killip class, clinical variables, treatment, revascularization, and in-hospital outcomes were compared between women and men. Analyses were additionally stratified by age group. Categorical variables were analyzed using chi-square or Fisher’s exact tests, and continuous variables using independent-samples t -tests or Mann–Whitney U tests, as appropriate. Effect estimates with 95% confidence intervals (CIs) were reported. Results Of 1,312 patients, 409 (31.2%) were women and 903 (68.8%) were men. Women more frequently presented with respiratory symptoms, other discomfort, gastrointestinal symptoms, and weakness/fatigue, whereas primary chest pain was more frequent among men. NSTEMI was more frequent among women than men (86.8% vs. 56.0%; OR 5.16, 95% CI 3.76–7.07; P < 0.001), while STEMI was more frequent among men. Higher Killip classes were more frequently observed among women ( P < 0.001). Women also demonstrated higher GRACE scores and lower eGFR. Treatment patterns differed between sexes, and primary PCI among STEMI patients was more frequently documented among men. In-hospital mortality did not differ significantly between women and men (6.1% vs. 5.3%; OR 1.16, 95% CI 0.70–1.91; P = 0.560). Age-stratified analyses demonstrated heterogeneous sex differences. Conclusion Sex-based differences in AMI were evident across presentation, infarction subtype, clinical risk profile, and treatment patterns, but were not associated with a significant difference in in-hospital mortality.

Discussion

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Cite This Study

Arain et al. (2026) conducted a cross-sectional in Acute myocardial infarction (AMI) (n=1,312). Female sex vs. Male sex was evaluated on In-hospital mortality (OR 1.16, 95% CI 0.70-1.91, p=0.560).

synapsesocial.com/papers/6af5cd33a40bbe8669e89c90 https://doi.org/10.21203/rs.3.rs-11205922/v1

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Sex-based differences in presentation, treatment, and complications among middle-aged and older adults hospitalized for acute myocardial infarction: a cross-sectional study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sex-based differences in presentation, treatment, and complications among middle-aged and older adults hospitalized for acute myocardial infarction: a cross-sectional study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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