Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction. in Frontiers in cardiovascular medicine / Front Cardiovasc Med. 2022 Jul 4;9:863811. doi: 10.3389/fcvm.2022.863811. eCollection 2022.
2022
AOU Città della Salute di Torino
Tipo pubblicazione
Journal Article
Autori/Collaboratori (40)Vedi tutti...
Ardissino D
University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy.
Magnani G
Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Duga S
Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
et alii...
Abstract
IMPORTANCE: There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure. METHODS: A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1-22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). RESULTS: ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52-0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up. CONCLUSIONS: There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes. TRIAL REGISTRATION: 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.
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PMID : 35859592
DOI : 10.3389/fcvm.2022.863811
Keywords
young; baseline risk differences; myocardial infarction; long term outcomes; gender;