Sex Differences in Patients Presenting With ST-Segment Elevation Myocardial Infarction and Nonobstructive Coronary
Mehmet Yildiz1,2, Madison Pico1,2, Timothy D Henry1
1The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
Insights
Sex differences in myocardial infarction with nonobstructive coronary arteries (MINOCA) and mimickers exist. Despite initial disparities, mortality risks were similar between sexes after adjusting for age and comorbidities.
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.
Background:
Sex differences in ST-segment elevation myocardial infarction (STEMI) due to obstructive coronary artery disease (CAD) are well-established, but limited research exists on sex differences in STEMI patients with nonobstructive coronary arteries (MINOCA) and MINOCA mimickers.
Methods:
We analyzed 8560 consecutive STEMI patients, enrolled in the Midwest STEMI Consortium from 2003 to 2020. Patients with non-obstructive CAD were classified into MINOCA (defined as < 50% coronary artery stenosis and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) and MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or non-ischemic cardiomyopathy). The primary outcome was 5-year all-cause mortality.
Results:
Of the 8560 patients, 409 (4.8%) had non-obstructive CAD, including 120 (1.4%) MINOCA and 289 (3.4%) MINOCA mimickers. Females were more likely to have MINOCA and MINOCA mimickers (49.2% and 56.4%, respectively). There were no significant sex differences in in-hospital or 5-year mortality in MINOCA, but females with MINOCA mimickers had higher unadjusted 5-year mortality (HR 2.90, 95% CI 1.53-5.53). After adjusting for age and comorbidities, the long-term mortality risk was similar between sexes (adjusted HR 1.16, 95% CI: 0.61-2.24). Females with obstructive CAD had higher 5-year mortality in unadjusted models (HR 1.66, 95% CI 1.48, 1.86), but the difference was not significant after adjustment (adjusted HR 1.1, 95% CI: 0.98-1.24).
Conclusions:
Our findings highlight important sex-based differences in the prevalence, treatment, and long-term outcomes of STEMI patients with MINOCA, MINOCA mimickers, and obstructive CAD. Despite clinical disparities, mortality risks were similar across sexes after adjusting for comorbidities.
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