Sex-Specific Trends and Predictors of Outcomes in Acute Myocardial Infarction in Almaty, Kazakhstan

Acute myocardial infarction (AMI) disproportionately affects older adults, highlighting the need for equitable, high-quality cardiovascular care. In Kazakhstan, recent primary health care reforms may have improved outcomes, but it remains unclear whether these gains are comparable for women and men. This study aimed to assess sex-specific trends in AMI outcomes and identify independent predictors of adverse clinical events.

We performed a two-stage retrospective study. Stage 1 analyzed 2018-2024 hospitalization data by sex. Stage 2 examined electronic records of 1,866 AMI patients from a tertiary cardiology center. Demographics, clinical parameters, and outcomes were collected. Statistical analysis included group comparisons and uni-/multivariable logistic regression using SPSS.

From 2018 to 2024, clinical improvement exceeded 90% annually except in 2021-2022, while mortality declined to 4.7%. Female were consistently presented at older ages than males and had less favorable baseline profiles, including lower hemoglobin levels and reduced renal function, whereas males had slightly higher creatinine levels and longer hospital stays. Hospital length of stay showed moderate variability with a post-pandemic increase, and hospitalization costs rose steadily for both sexes. Among 1,866 patients, hypertension was highly prevalent and 6.4% died. Deceased patients were older and showed worse hemodynamic, renal, metabolic, and inflammatory profiles with lower ejection fraction. In multivariable analysis, sex was not an independent predictor, while age, glucose, non-ST-elevation myocardial infarction (NSTEMI) status, systolic blood pressure, hemoglobin, glomerular filtration rate, and ejection fraction remained significant.

Advanced age, metabolic and renal dysfunction, hemodynamic instability, and impaired cardiac function were the strongest predictors of adverse outcomes, while NSTEMI presentation and better physiological status were associated with lower mortality. Females presented at older ages with less favorable risk profiles; although sex was not an independent predictor after adjustment, these differences underscore the need for tailored, risk-stratified care for high-risk patients.