The Outcome of ST-elevation Myocardial Infarction By Sex: A Retrospective Cohort Study

Abstract

We aimed to compare in-hospital mortality (IHM) of acute myocardial infarction (AMI) between male and females. We assessed the association of sex with IHM after AMI using simple and multivariate cox regression models. Results were presented as crude and adjusted hazard ratios along with their 95% confidence interval (HR; 95% CI). Multivariable Cox regression analysis revealed females had a higher risk of death than males after ST-elevation MI (STEMI) (adjusted HR [95% CI]: 1.64 [1.15–2.36]; p = 0.007). In subgroup analysis by age group, this significantly increased risk was only observed in 50- to 64-year-old females. There were no significant differences between genders after non-STEMI and unspecified MI. Women aged 50 to 64 years had higher IHM after STEMI than men.

Plain language summary

What is this study about?

Cardiovascular diseases are one of the leading causes of death and disability in both males and females worldwide. Over the few last decades, with the development of novel techniques for the treatment of heart attacks, its prognosis has dramatically improved, although adverse outcomes remain high in female patients. Nevertheless, sex differences in death rates following heart attacks are still poorly understood. Hence, we compared the in-hospital death rate between male and female patients following a heart attack.

What were the study results?

Women are more likely to die during hospitalization following a heart attack in which the artery supplying the heart muscle was completely blocked, when compared with similarly aged men. This increased risk was most prominent between 50 to 64 years of age. However, the risk of in-hospital death was similar between men and women following a heart attack in which the artery supplying the heart muscle was not completely blocked.

What do the results of the study mean?

Women who have a heart attack with complete blockage of an artery supplying heart muscle are more likely to die during hospitalization when compared with men.

Keywords:

• in-hospital mortality
• myocardial infarction
• NSTEMI
• sex difference
• STEMI

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at:www.tandfonline.com/doi/full/10.2217/fca-2022-0064

Author contributions

NS Hassani and H Rastad had the idea and designed the study with R Pirdehghan and P Mardi. M Mozafarybazargany, R Sepahvandi, Z Khodaparast, F Karimi, F Rahimi, A Zakani, P Mardi collected the clinical data. Z Kamipoor, M Dorri, A Bamrafie summarized all data. H Rastad and NS Hassani analyzed and interpreted the information. All authors have participated to drafting the manuscript. H Rastad, N Shafiabadi revised it critically. All authors read and approved the final version of the manuscript.

Acknowledgments

Researchers appreciated the Clinical Research Development units of Kamali and Rajaee Hospitals in Alborz University of Medical Sciences.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

We performed this research in line with the Declaration of Helsinki guidelines. Research and Ethics Committee of Alborz University of Medical Sciences (ABZUMS) reviewed the study proposal and waived the requirement for informed consent. A unique identifier number was assigned to each patient at the hospital EER system to protect confidentiality. Also informed consent was obtained from all individual participants included in the study.

Written consent for publication was obtained from all individual participants included in the study.