Exploring sex differences in mortality among acute myocardial infarction

Area of Science:

• Cardiology
• Public Health
• Sex Differences in Medicine

Background:

• Women with acute myocardial infarction (AMI) exhibit higher mortality rates compared to men.
• Contributing factors include older age, increased comorbidities, atypical symptoms, and treatment delays.
• This study investigates sex-based disparities in AMI outcomes within the Italian Lombardy Health Database.

Purpose of the Study:

• To analyze sex differences in in-hospital and 1-year mortality following AMI.
• To evaluate the mediating roles of age, percutaneous coronary intervention (PCI), and postdischarge therapy in these disparities.
• To identify key factors contributing to the observed mortality gap between men and women with AMI.

Main Methods:

• Analysis of a large cohort of AMI patients (2003-2018) from the Lombardy Health Database.
• Path analysis to assess direct and indirect effects of sex on mortality, considering age, PCI, and postdischarge therapy as mediators.
• Comparison of in-hospital and 1-year mortality rates, PCI utilization, and postdischarge therapy adherence between sexes.

Main Results:

• Women experienced higher in-hospital (10% vs 5%) and 1-year (24% vs 14%) mortality.
• Women were less likely to receive PCI (40% vs 61%) and various postdischarge therapies.
• After adjusting for age and treatment, mortality differences became non-significant or reversed, with age and undertreatment explaining the majority of the disparity.

Conclusions:

• Higher mortality in women with AMI is largely attributable to older age and undertreatment during and after hospitalization.
• Addressing undertreatment and age-related factors is crucial for improving outcomes in female AMI patients.
• The findings highlight the need for targeted interventions to reduce sex-based disparities in cardiovascular care.