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Does the patient's sex influence cardiovascular outcome after acute myocardial infarction?
Scott E Woods1, Prasanna Chandran, Linda Levin
1Director of Epidemiology, Bethesda Family Practice Residency Program, 4411 Montgomery Rd., Suite 200, Cincinnati, OH 45212, USA. liverdoctor@yahoo.com
Insights
Most heart attack outcomes are similar for men and women. Men had more coronary artery bypass grafting (CABG) due to more severe coronary artery disease, not sex differences.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Sex Differences in Medicine
Background:
- Myocardial infarction (MI) affects both men and women, but sex-based outcome disparities are not fully understood.
- Previous research suggests potential differences in treatment and outcomes following acute cardiovascular events.
Purpose of the Study:
- To investigate if patient sex influences outcomes after myocardial infarction (MI).
- To compare cardiovascular outcomes and treatment patterns between men and women hospitalized with MI.
Main Methods:
- A large cohort study was conducted, including 1669 patients diagnosed with acute or subendocardial infarction.
- Data collected at discharge included patient demographics, comorbidities, and specific cardiovascular procedures and outcomes.
- Eight key outcomes were analyzed: angiogram, angioplasty, stent placement, coronary artery bypass grafting (CABG), mortality, ICU length of stay, total length of stay, and combined catheterization procedures.
Main Results:
- After adjusting for confounding variables, no significant sex differences were observed in mortality, ICU time, total hospital stay, stent placement, angiogram, angioplasty, or combined catheterization procedures.
- Men showed a significantly higher rate of coronary artery bypass grafting (CABG) (RR 1.96).
- Among patients undergoing CABG, men had a higher prevalence of three-vessel and left main coronary artery disease; this difference explained the higher CABG rate in men.
Conclusions:
- During hospitalization for myocardial infarction (MI), most cardiovascular outcomes and process measures are comparable between men and women.
- The observed higher frequency of CABG in men is attributed to their greater prevalence of complex coronary artery disease, rather than sex-based treatment bias.
Objectives:
To determine whether outcome differences based on the patient's sex occur after myocardial infarction (MI) at a large private hospital.
Study Design:
We conducted a large cohort study.
Population:
Inclusion required hospital admission between January 1, 1998, and June 30, 1999, and a diagnosis of acute MI or subendocardial infarction. The number of patients included in the study was 1669. Data were collected at discharge on age, sex, race, health insurance, hypercholesterolemia, diabetes, smoking, hypertension, and the extent of coronary artery disease.
Outcomes Measured:
The 8 outcomes analyzed were angiogram, angioplasty, stent placement, coronary artery bypass grafting (CABG), mortality, time in the intensive care unit, total length of stay, and combined catheterization procedures.
Results:
After adjusting for 7 confounding variables, we found no significant differences between men and women for mortality, ICU time, total hospital time, stent placement, angiogram, angioplasty, or combined catheterization procedures. Men had significantly more CABG (relative risk [RR] 1.96, P <.01). Among patients who underwent CABG (N = 204), men had significantly more 3-vessel coronary disease (RR 1.44, P <.01) and left main coronary artery disease greater than 50% (RR 1.58, P <.01). Once we had controlled for the extent of coronary artery disease, we found no difference between the sexes for CABG.
Conclusions:
During hospitalization after an MI, most cardiovascular outcomes and process measures are the same for men and women. The greater frequency of CABG in men than in women is explained by men's greater frequency of 3-vessel and advanced left-main coronary disease.
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