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Sex Differences in Myocardial Injury: Clinical Characteristics, Outcomes, and Prognostic Implications
Mar Rocamora-Horrach1,2,3, Óscar M Peiró1,2,3, Alfredo Bardají1,2,3
1Department of Cardiology, Joan XXIII University Hospital, 43005 Tarragona, Spain.
Journal of Clinical Medicine
|February 27, 2026
Summary
Sex significantly impacts myocardial injury presentation and prognosis. Men have higher mortality, while women face increased risks of future myocardial infarction (MI) and heart failure (HF).
Area of Science:
- Cardiology
- Sex-based medicine
- Clinical outcomes research
Background:
- Myocardial injury is a known predictor of adverse outcomes.
- The influence of sex on myocardial injury presentation, management, and prognosis requires further investigation.
- Understanding sex-specific differences is crucial for optimizing patient care in tertiary hospital settings.
Purpose of the Study:
- To examine sex-based differences in the presentation, management, and prognosis of myocardial injury.
- To compare clinical characteristics, management strategies, and short- and long-term outcomes between men and women with myocardial injury.
- To assess potential interactions between sex and myocardial injury regarding long-term outcomes.
Main Methods:
- Retrospective observational study of 3620 emergency department patients undergoing troponin testing (January 2012-December 2013).
- Myocardial injury classified as type 1 myocardial infarction (T1MI), type 2 myocardial infarction, or non-ischemic myocardial injury (NIMI).
- Comparison of clinical characteristics, management, and outcomes by sex, with a median follow-up of four years; interaction analyses performed.
Main Results:
- Myocardial injury was more prevalent in men (31.4% vs. 25.8%), with male sex independently associated with increased risk.
- Non-ischemic myocardial injury (NIMI) was more common in women, while type 1 myocardial infarction (T1MI) predominated in men.
- Women experienced lower hospitalization rates but higher adjusted risks of future myocardial infarction (MI) and heart failure (HF); men had higher adjusted long-term mortality.
Conclusions:
- Significant sex differences exist in myocardial injury types and prognoses.
- Women with myocardial injury have an elevated risk of subsequent MI and HF.
- Men with myocardial injury exhibit a higher risk of long-term mortality, with no significant interaction found between sex and myocardial injury for overall outcomes.
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