Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive
Nina Johnston1, Birgitta Jönelid2, Christina Christersson2
1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
Patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) have different prognoses. Women with NSTEMI without obstructive CAD had lower mortality and heart failure risk compared to men.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Prognostics
Background:
- Myocardial infarction (MI) patients without obstructive coronary artery disease (CAD) represent a distinct clinical subgroup.
- Understanding gender-specific risks and prognoses in MI subtypes is crucial for targeted treatment strategies.
Purpose of the Study:
- To compare prognoses of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients without obstructive CAD.
- To assess gender-associated risks for future cardiovascular events in these patient groups.
Main Methods:
- Analysis of 95,849 MI patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) (2005-2010).
- Outcome analysis in 2,268 STEMI and 10,904 NSTEMI patients without obstructive CAD (<50% stenosis).
- Calculation of hazard ratios comparing women and men for mortality, MI, heart failure, stroke, and revascularization, adjusted for risk factors and age.
Main Results:
- Nonobstructive CAD was more prevalent in NSTEMI (17%) than STEMI (7%), and in women (10% STEMI, 28% NSTEMI) compared to men (6% STEMI, 11% NSTEMI).
- During a median 2.6-year follow-up, mortality was 8% for STEMI and 5% for NSTEMI.
- In NSTEMI patients without obstructive CAD, women showed lower adjusted risks for mortality (HR 0.90) and heart failure (HR 0.61) compared to men. Women also underwent less revascularization.
Conclusions:
- Nonobstructive CAD is more common in NSTEMI and in women across MI types.
- Long-term mortality is higher following STEMI compared to NSTEMI in patients with nonobstructive CAD.
- Observed gender differences in outcomes suggest distinct underlying pathogenetic mechanisms in MI without obstructive CAD.
Abstract:
The aim of this study was to compare the prognoses of patients with ST-segment elevation myocardial infarction (STEMI) and those with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) and the risk associated with gender for future cardiovascular events. The study population was selected from 95,849 patients who underwent coronary angiography for myocardial infarction from 2005 to 2010 and registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Outcome analyses, including all-cause death, myocardial infarction, congestive heart failure, stroke, and revascularization, were performed in 2,268 patients with STEMI and 10,904 with NSTEMI without obstructive CAD (<50% stenosis). Hazard ratios and 95% confidence intervals comparing women with men were calculated for events, adjusting for cardiovascular risk factors and age. Nonobstructive CAD was found in 7% of patients with STEMI (6% men, 10% women) and in 17% of those with NSTEMI (11% men, 28% women). During a median follow-up of 2.6 years, 8% of patients with STEMI and 5% of those with NSTEMI died. Gender-associated differences in risk were observed in patients with NSTEMI, with adjusted hazard ratios lower in women than men for mortality (hazard ratio 0.90, 95% confidence interval 0.50 to 0.73) and congestive heart failure (hazard ratio 0.61, 95% confidence interval 0.52 to 0.72). In the 2 groups, women underwent less revascularization. In conclusion, nonobstructive CAD was more common in patients with NSTEMI than those with STEMI, as well as in women compared with men. Long-term mortality in patients with nonobstructive CAD was higher after STEMI than NSTEMI. The gender differences in outcomes suggest gender differences in the underlying pathogenesis of myocardial infarction without obstructive CAD.
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