Sex differences in cognitive and psychological outcomes following acute ischemic cardiac events: a cross-sectional study

Background Sex differences in cardiovascular outcomes are well established; however, sex-specific cognitive and psychological recovery following acute ischemic cardiac events remains underexplored. This study examined sex differences in early cognitive and psychological outcomes following out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI). Methods Fifty-eight patients hospitalized for OHCA or STEMI completed a web-based cognitive battery assessing memory, reasoning, and verbal abilities, along with validated measures of anxiety and depression, approximately 24–48 h prior to discharge. Cognitive performance was compared to age- and sex-matched normative data. Group differences were assessed using one-sample and independent samples t-tests, non-parametric equivalents where appropriate, and multivariate analysis of variance (MANOVA) to evaluate sex effects across cognitive domains. Results Participants demonstrated significant cognitive impairment across all domains relative to normative controls. While cognitive performance did not differ significantly by sex, female patients reported substantially higher levels of anxiety and depressive symptoms than male patients, with mean scores exceeding clinical screening thresholds. Conclusions Acute survivors of ischemic cardiac events demonstrated broad cognitive impairment in the early recovery period, but the most clinically salient sex difference was observed in psychological outcomes, whereby female patients reported significantly greater symptoms during the earliest stage of recovery. These findings highlight the importance of early and routine mental health screening and targeted psychosocial support for female survivors of ischemic cardiac events.