What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=4890). Intervention: Male sex vs. Female sex. Primary outcome: 1-year all-cause mortality (HR 0.821, 95% CI 0.684-0.987, p=0.011).

April 9, 2025Open Access

Sex differences in outcomes in patients with acute myocardial infarction

Q: What does this research mean for the field?

Women with acute myocardial infarction have a higher 1-year mortality risk but a lower risk of in-hospital ventricular arrhythmias compared to men. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Men with acute myocardial infarction had a 17.9% lower adjusted risk of 1-year all-cause mortality compared to women (HR 0.821).

Study Design

Type

Cohort (n=4,890)

Multicenter

Yes

Structured PICO

Does male sex compared to female sex affect the risk of 1-year all-cause mortality and in-hospital complications in patients with acute myocardial infarction?

Population

4,890 patients with acute myocardial infarction (AMI) from the MIMIC-III and MIMIC-IV databases, aged 18-90 years. Mean age 64.87 in males and 70.08 in females, 65.7% male.

Intervention

Male sex

Comparator

Female sex

Outcome

1-year all-cause mortalityhard clinical

In patients with acute myocardial infarction, women have a higher 1-year all-cause mortality but a lower risk of in-hospital ventricular arrhythmias compared to men.

Main Result

Effect estimate: HR 0.821 (95% CI 0.684-0.987)

Absolute Event Rate: 22.5% vs 33.2%

p-value: p=0.011

Limitations

Observational study based on a single-center database, subject to confounding by patient and clinician treatment preferences
Unable to classify all subjects into STEMI and NSTEMI cohorts based on ICD codes
Short follow-up period that did not consider the incidence of heart failure after AMI and the rate of rehospitalization for heart failure

Abstract

OBJECTIVE: Gender is a vital factor for the development and treatment of cardiovascular diseases. This study aimed to evaluate sex-based differences in the prognosis of patients with acute myocardial infarction (AMI). METHODS: AMI patients who had been registered in the MIMIC III and IV database were enrolled. The primary study endpoint was 1-year all-cause mortality. The secondary study endpoints were in-hospital all-cause mortality, 28-day all-cause mortality, in-hospital complications of acute kidney injury (AKI) and ventricular arrhythmias (VA). Kaplan-Meier analysis was used to assess survival rate between the two groups. Cox proportional hazards regression and logistic regression analyses were performed to evaluate whether gender is an independent predictor of prognosis of AMI patients. RESULTS: A total of 4890 patients with AMI were included. At 1-year follow-up, 722 (22.5%) men died and 558 (33.2%) women died, and after analysis and adjustment, men had a 17.9% lower risk of all-cause mortality compared to women Hazard Ratio (HR) = 0.821, 95% confidence interval (CI): 0.684-0.987. Kaplan-Meier survival analysis showed a higher 1-year survival rate in the male group compared with the female group (HR = 0.532, 95% CI: 0.444-0.638, log-rank P < 0.0001). There was no significant difference in AKI during hospitalization. After adjusting for multivariable analysis, men with AMI had a 25% increased risk of hospitalization for VA compared to women odds ratio (OR) = 1.250, 95% CI:1.030-1.518. CONCLUSION: Women had a higher 1-year mortality but a lower risk of ventricular arrhythmias (VA) during AMI compared to men. CLINICAL TRIAL APPROVAL STATEMENT: This Trial was registered in the Chinese clinical trials registry: ChiCTR1800014583. Registered 22 January 2018 ( http://www.chictr.org.cn/searchproj.aspx ).

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