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Sex differences in outcomes in patients with acute myocardial infarction
Dabei Cai1,2, Li Deng3, Ye Deng3
1Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, 299# Qingyang Road, Wuxi, Jiangsu, 214001, China.
Insights
Men with acute myocardial infarction (AMI) have a lower 1-year mortality risk than women. However, men experienced a higher risk of ventricular arrhythmias (VA) during hospitalization.
Area of Science:
- Cardiology
- Medical Research
- Clinical Outcomes
Background:
- Cardiovascular diseases, including acute myocardial infarction (AMI), exhibit significant sex-based differences in development and treatment.
- Understanding these gender-based disparities is crucial for optimizing patient care and improving prognoses.
Purpose of the Study:
- To investigate and compare the 1-year prognosis of male and female patients following acute myocardial infarction (AMI).
- To identify sex-based differences in mortality and in-hospital complications, such as acute kidney injury (AKI) and ventricular arrhythmias (VA).
Main Methods:
- Analysis of 4890 patients diagnosed with AMI from the MIMIC III and IV databases.
- Kaplan-Meier analysis for survival rates and Cox/logistic regression for predictor evaluation.
- Primary endpoint: 1-year all-cause mortality; Secondary endpoints: in-hospital mortality, 28-day mortality, AKI, and VA.
Main Results:
- Men demonstrated a 17.9% lower risk of 1-year all-cause mortality compared to women (HR=0.821).
- Kaplan-Meier analysis revealed a significantly higher 1-year survival rate in men (HR=0.532, P < 0.0001).
- Men with AMI showed a 25% increased risk of hospitalization for ventricular arrhythmias (VA) (OR=1.250), with no significant difference in AKI.
Conclusions:
- Women with AMI face higher 1-year mortality rates compared to men.
- Despite higher overall mortality, women exhibit a lower risk of ventricular arrhythmias (VA) during acute myocardial infarction.
- Gender is a significant factor influencing both survival and complication risks post-AMI.
Objective:
Gender is a vital factor for the development and treatment of cardiovascular diseases. This study aimed to evaluate sex-based differences in the prognosis of patients with acute myocardial infarction (AMI).
Methods:
AMI patients who had been registered in the MIMIC III and IV database were enrolled. The primary study endpoint was 1-year all-cause mortality. The secondary study endpoints were in-hospital all-cause mortality, 28-day all-cause mortality, in-hospital complications of acute kidney injury (AKI) and ventricular arrhythmias (VA). Kaplan-Meier analysis was used to assess survival rate between the two groups. Cox proportional hazards regression and logistic regression analyses were performed to evaluate whether gender is an independent predictor of prognosis of AMI patients.
Results:
A total of 4890 patients with AMI were included. At 1-year follow-up, 722 (22.5%) men died and 558 (33.2%) women died, and after analysis and adjustment, men had a 17.9% lower risk of all-cause mortality compared to women [Hazard Ratio (HR) = 0.821, 95% confidence interval (CI): 0.684-0.987]. Kaplan-Meier survival analysis showed a higher 1-year survival rate in the male group compared with the female group (HR = 0.532, 95% CI: 0.444-0.638, log-rank P < 0.0001). There was no significant difference in AKI during hospitalization. After adjusting for multivariable analysis, men with AMI had a 25% increased risk of hospitalization for VA compared to women [odds ratio (OR) = 1.250, 95% CI:1.030-1.518].
Conclusion:
Women had a higher 1-year mortality but a lower risk of ventricular arrhythmias (VA) during AMI compared to men.
Clinical Trial Approval Statement:
This Trial was registered in the Chinese clinical trials registry: ChiCTR1800014583. Registered 22 January 2018 ( http://www.chictr.org.cn/searchproj.aspx ).
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