MI Care Varies by Sex Even Though Death Risk Similar

TOPLINE:

Patients with ST-segment elevation myocardial infarction (STEMI), classified as having MI with nonobstructive coronary arteries (MINOCA) or MINOCA mimickers, exhibit sex-based differences in prevalence and treatment, but the 5-year mortality risk remains similar between sexes after adjusting for confounders.

METHODOLOGY:

• Researchers analyzed data of 8560 patients with STEMI prospectively enrolled in a consortium in the United States (2003-2020) to evaluate the sex differences in patients with nonobstructive coronary artery disease.
• Of the patients with nonobstructive coronary artery disease (4.8%), 1.4% had MINOCA (defined as having less than 50% coronary artery stenosis and including confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) and 3.4% had MINOCA mimickers (which included takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy).
• Patients having spontaneous coronary artery dissection with more than 50% obstructive lesions were classified as having obstructive coronary artery disease (95.2%).
• The primary outcome was 5-year all-cause mortality, with follow-up data being collected using electronic medical records and the national death index.
• The median duration of the follow-up was 7.1 years.

TAKEAWAY:

• Overall, 49.2% and 56.4% of women had MINOCA and MINOCA mimickers, respectively, but only 29.3% of women had obstructive coronary artery disease.
• Among patients with MINOCA, the risk for 5-year mortality was similar between men and women, while the length of hospital stay was longer for women than for men (median days, 2 vs 1; P
• Among patients with MINOCA mimickers, the risk for 5-year mortality was similar between men and women. However, women had a longer length of hospital stay than men (median days, 3 vs 2; P P
• Among patients with obstructive coronary artery disease, the risk for 5-year mortality was similar between men and women. Women had a longer length of hospital stay than men (median days, 3 vs 2; P P

IN PRACTICE:

“Our findings emphasize the need to consider sex-specific factors in STEMI [ST-segment elevation MI] treatment and management,” reported the authors.

SOURCE:

This study was led by Mehmet Yildiz, MD, and Madison Pico, MD, of The Christ Hospital in Cincinnati. It was published online on February 5, 2025, in Catheterization & Cardiovascular Interventions.

LIMITATIONS:

This study was observational in nature with unmeasured confounding factors and adjudication of events. The angiographic images were not assessed by a core laboratory. Cardiac MRI and intravascular imaging were underutilized due to the lack of standardized protocols for MINOCA and MINOCA mimickers. Additionally, the follow-up relied on the use of the national death index and electronic medical records, and detailed data on cause of death were not consistently available.

DISCLOSURES:

This study was supported by the National Institutes of Health and the Minneapolis Heart Institute Foundation. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.