2023-05-03 04:01:26
Young women hospitalized for acute myocardial infarction (AMI) have higher in-hospital mortality compared with men of a similar age, and this disparity may be worsening over time. It has been shown that, after the index episode, they present higher rates of recurrent hospitalization and a worse state of health. What has not yet been established is the pattern of sex differences in adverse events occurring in the year after hospital discharge.
researchers of the Yale School of Medicine (USA) used study data VIRGO, Observational study to determine the presentation, treatment, and outcomes of young women and men who suffered a myocardial infarction between the ages of 18 and 55 years. A total of 2,985 American patients (2,009 women vs. 976 men) hospitalized for the condition were included. After excluding in-hospital deaths, the final cohort included 2,979 patients (2,007 women vs. 972 men).
Acute all-cause and cause-specific events requiring hospitalization were examined, defined as any stay or observation longer than 24 hours within one year of discharge for myocardial infarction. The events were classified as follows:
1. Hospitalization related to AMI.
2. Other cardiac or stroke hospitalizations.
3. Non-cardiac hospitalization.
Women also had a higher prevalence of comorbidities, such as obesity, congestive heart failure, previous stroke, and kidney disease. The patient cohort was more likely to have low income, a history of depression, and significantly worse health status than the men in the study.
According to the researchers, women were less likely to present to the hospital with chest pain and more likely to arrive more than six hours after the onset of symptoms. They were also more likely to have a non-ST-segment elevation myocardial infarction or a myocardial infarction with non-obstructive coronary arteries (MINOCA). Those who experienced MINOCA were younger, more likely to be non-Hispanic black, smokers, had lower educational level, and had the lowest proportion of prior coronary artery disease.
These patients also reported lower treatment satisfaction compared to men or women presenting with myocardial infarction with obstructive coronary disease (CAD-MI). On average, they stayed longer in hospital and received fewer guideline-recommended medical treatments, such as aspirin, statins, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.
Hospitalization rates for any cause one year after discharge were 34.8% for women and 23% for men. The leading cause of hospitalization for women was coronary-related, followed by non-cardiac hospitalizations, and then other cardiac-related hospitalizations and stroke. Women with MINOCA had lower 1-year outcome rates compared with women with IM-CAD. There was a more significant gender disparity between women and men in noncardiac hospitalizations compared to all other hospitalizations (145.8 vs. 69.6 per 1,000 person-years).
The findings demonstrate the need for further efforts to optimize secondary preventive strategies to reduce coronary-related hospitalizations, but also highlight the need for further investigation of the causes and mechanisms of noncardiac hospitalization, especially given the significant disparity between sexes.
Limitations of the study include that details of noncardiac hospitalizations were not collected and that the results may not be generalizable to population groups underrepresented in the study cohort.
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