Disclosures: The authors report no relevant financial disclosures.
February 03, 2021
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Women have lower MI incidence but, in younger patients, worse MI mortality vs. men

Disclosures: The authors report no relevant financial disclosures.
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Women had lower incidences of MI and underwent fewer invasive treatments compared with men, according to study data published in Mayo Clinic Proceedings.

However, sex differences in MI mortality varied by age, as women with MI were more likely to die than men with MI in younger age groups but not in older ones, according to the researchers.

Woman having heart attack
Source: Adobe Stock

“Sex-based disparities have been documented in the incidence, management and outcomes of MI, with the majority of studies documenting a clear association between female sex with less likelihood of referral to invasive treatment and with worse outcomes,” Mohamad Alkhouli, MD, interventional cardiologist and professor of medicine at Mayo Clinic, and colleagues wrote. “However, some studies suggested that the interaction between female sex and the management and outcomes of MI might be age specic.”

To assess the impact of sex on MI in different age groups, researchers analyzed 6,720,639 hospitalizations for STEMI or non-STEMI. Researchers compared STEMI rates with non-STEMI rates as well as management patterns and risk-adjusted in-hospital mortality rates stratified by age group (< 45 years, 45-64 years, 65-84 years and 85 years).

The researchers found a lower incidence rate of MI hospitalization in women compared with men across all age groups; researchers also noted women were less likely than men to undergo coronary angiography, to receive revascularization or to utilize circulatory-support devices.

In both the STEMI and non-STEMI cohorts, women were more likely than men to die of their MI in the younger age brackets, but not in the older ones (non-STEMI: < 45 years, adjusted OR = 1.08; 95% CI, 0.97-1.2; 45-64 years, aOR = 1.05; 95% CI, 1.02-1.08; 65-84 years, aOR = 0.92; 95% CI, 0.91-0.94; 85 years, aOR = 0.86; 95% CI, 0.85-0.88; STEMI: < 45 years, aOR = 1.15; 95% CI, 1.04-1.27; 45-64 years, aOR = 1.22; 95% CI, 1.18-1.26; 65-84 years, aOR = 1.09; 95% CI, 1.06-1.11; 85 years, aOR = 0.97; 95% CI, 0.94-0.99).

“In a large contemporary U.S. cohort, women have lower incidence of acute MI and less likelihood of undergoing invasive treatment compared with men, regardless of their age,” Alkhouli and colleagues concluded. “However, post-MI outcomes are age specic, and the negative impact of female sex on most outcomes appears to be conned to young and middle-aged women.”