Sex-specific differences in first event of st- elevation myocardial infarction; new insights on age-related mortality. (14th October 2021)

• Record Type: Journal Article
• Authors: Fischer, A J; Feld, J; Kuehnemund, L; Makowski, L; Engelbertz, C M; Guenster, C; Gerss, J; Droege, P; Ruhnke, T; Lange, S A; Reinecke, H; Freisinger, E; Koeppe, J
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Epidemiology, Prognosis, Outcome; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.1110
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: For patients with ST-elevation myocardial infarction (STEMI) as the primary manifestation of coronary artery disease (CAD), data on predictors and outcome are limited. We hypothesized that specifically age and sex influence short- and long-term outcome in patients after first event of STEMI. Methods and results: Based on claims data of the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse) (≈26 million insurance holders in Germany with ≈83 million inhabitants), adults with STEMI between 01/2014 to 12/2015 and no history of CAD were selected for further analysis. Patient demographics, details on in-hospital treatment as well as age- and sex-related differences in 30-day mortality, re-infarction/ death, major adverse cardiovascular events (MACE), overall and long-term survival were assessed. Overall, 17, 444 patients presented with STEMI as the primary manifestation of CAD throughout the study period, thereof 33% were women. At index, women were older compared to men (median age 74 years vs. 60 years) and suffered from more cardiovascular comorbidities such as diabetes (35.8% vs. 25.2% in men), chronic kidney disease (26.0% vs. 14.9% in men), and arterial hypertension (84.6% vs. 72.6%; all p<0.001). Women with STEMI underwent endovascular reperfusion (78.5% vs. 88.1%) or coronary artery bypass grafting (4.2% vs. 5.5%; both p<0.001) less frequently. In-hospital complications such as shock (19.2% vs. 16.0%) and resuscitation (15.1% vs. 12.9%; both p<0.001) were observed more often in women. Female sex was independently associated with adjusted 30-day mortality (Odds Ratio 1.17; p=0.01). Long-term outcomes revealed women to be at increased risk of the combined end-point of re-infarction and/or death (Hazard ratio (HR) 1.09; p=0.01), MACE (HR 1.09; p=0.01) and all-cause mortality (HR 1.10; p=0.01). Particularly in patients younger than 60 years, female sex was a strong predictor of adverse outcomes. Surprisingly, among patients that survived at least 90 days after STEMI, no differences between the sexes were noted regarding long-term survival (HR 0.99; p=0.91) (see Figure for adjusted odds/hazard ratios presenting the association of sex with different endpoints depending on age after first event of STEMI). Conclusion: On non-selective data, two-thirds of patients with STEMI as the primary manifestation of CAD were male. Women were observed to receive endovascular reperfusion less frequently than men and suffered from more in-hospital complications. Being female and younger than 60 years was associated with an increased risk of adverse outcomes specifically early after STEMI. Funding Acknowledgement: Type of funding sources: Other. Main funding source(s): The study is part of the GenderVasc project funded by the joint federal committee, Germany.