Sex Differences in Patients Presenting With ST-Segment Elevation Myocardial Infarction and Nonobstructive Coronary...

Area of Science:

• Cardiology
• Clinical Research
• Sex Differences in Medicine

Background:

• Sex differences in ST-elevation myocardial infarction (STEMI) with obstructive coronary artery disease (CAD) are known.
• Limited research exists on sex differences in STEMI patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA) and MINOCA mimickers.

Purpose of the Study:

• To investigate sex-based differences in the prevalence, characteristics, and outcomes of STEMI patients with MINOCA and MINOCA mimickers.
• To compare long-term mortality between sexes in STEMI patients with obstructive CAD, MINOCA, and MINOCA mimickers.

Main Methods:

• Analysis of 8560 STEMI patients from the Midwest STEMI Consortium (2003-2020).
• Classification of patients with non-obstructive CAD into MINOCA or MINOCA mimickers (e.g., takotsubo cardiomyopathy, myocarditis).
• Primary outcome: 5-year all-cause mortality, analyzed with adjustments for age and comorbidities.

Main Results:

• Of 8560 STEMI patients, 4.8% had non-obstructive CAD (1.4% MINOCA, 3.4% MINOCA mimickers).
• Females were more prevalent in both MINOCA and MINOCA mimicker groups.
• No significant sex differences in 5-year mortality for MINOCA; females with MINOCA mimickers had higher unadjusted mortality, but this normalized after adjustment.

Conclusions:

• Significant sex-based differences exist in the prevalence and presentation of STEMI patients with MINOCA and MINOCA mimickers.
• While initial mortality disparities were observed, long-term mortality risks were comparable between sexes after adjusting for confounding factors.
• Findings underscore the importance of considering sex in the management and risk stratification of STEMI patients, particularly those with non-obstructive coronary findings.