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Updated: Jan 23, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction
Annette Marie Maznyczka1,2, David Carrick1,2, Jaclyn Carberry1,2
1British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Objectives:
We aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).
Methods:
Patients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up.
Results:
In 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation.
Conclusion:
There were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women.
Trial Registration Number:
NCT02072850.
Insights
This study found no sex differences in microvascular injury after ST-segment elevation myocardial infarction (STEMI). While women had fewer anterior infarcts, key outcomes like major adverse cardiovascular events were similar between sexes.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Sex differences in outcomes after ST-segment elevation myocardial infarction (STEMI) are observed, but microvascular reperfusion injury and infarct characteristics require further investigation.
- Understanding these differences is crucial for optimizing treatment strategies and improving patient outcomes following acute myocardial infarction.
Purpose of the Study:
- To evaluate potential sex-based disparities in invasive microvascular reperfusion injury parameters and infarct characteristics assessed by cardiac MRI post-STEMI.
- To determine if sex influences long-term major adverse cardiovascular events (MACE) and mortality after STEMI.
Main Methods:
- Prospective enrollment of STEMI patients undergoing percutaneous coronary intervention (PCI).
- Measurement of index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) post-PCI.
- Cardiac MRI assessment of infarct characteristics, microvascular obstruction, and myocardial hemorrhage at 2 days and 6 months.
- 5-year follow-up for MACE and all-cause death/heart failure hospitalization.
Main Results:
- In 324 STEMI patients (87 women, 237 men), women presented less often with anterior STEMI and received fewer beta-blocker prescriptions at discharge.
- Despite differences in initial perfusion (TIMI grades, corrected TIMI frame counts), invasive parameters (IMR, CFR) and MRI-derived infarct characteristics did not differ significantly between sexes.
- Female sex was not associated with increased risk for MACE or death/heart failure hospitalization over 5 years.
Conclusions:
- No significant sex differences were found in acute microvascular pathology or infarct characteristics following STEMI.
- Observed differences in infarct location and discharge medication do not translate to differential long-term cardiovascular outcomes between men and women.
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