Sex-specific outcomes in myocardial infarction: a dual-cohort analysis using clinical and real-world data

Sex-related differences in symptoms, treatment, and outcomes in patients presenting with myocardial infarction have been reported but vary largely between studies. We sought to characterize sex differences in presentation and outcomes of patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).

We included 1206 STEMI patients from a clinical cohort and 35,123 STEMI patients obtained from the German health insurance claims. Women, despite being older and thus having a worse cardiovascular risk profile, had greater myocardial salvage and smaller infarct size than men in all patients (median with [interquartile ranges (25th-75th percentiles), IQR]; salvage index: 0.58 [IQR: 0.32-0.91] in females vs. 0.47 [IQR: 0.23-0.77] in males, p < 0.0001; infarct size: 7.0% [IQR: 1.0-22.0%] in females vs. 11.0% [IQR: 3.0-23.0%] of the left ventricle in males, p = 0.002). Same results were shown for propensity score matched pairs (n = 242) (salvage index: 0.60 [IQR: 0.33-0.91] in females vs. 0.44 [IQR: 0.23-0.70] in males, p = 0.0002; infarct size: 7.0% [IQR: 1.0-23.0%] vs. 10% [IQR: 3.0-23.0%] of the left ventricle in males, p = 0.042). Furthermore, women showed a lower risk of 5-year mortality, assessed after propensity score matching, in the health insurance cohort (n = 19,404) (HR = 0.92 [95% CI 0.87-0.97], p = 0.002).

In patients with STEMI, women appear to have better myocardial salvage and smaller infarct size after PPCI and a lower 5-year mortality compared with men, suggesting better ischemic tolerance in female patients.