Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction

Frontiers in Cardiovascular Medicine

article

Maddalena Ardissino¹  Adam J. Nelson²  Giuseppe Maglietta⁴  Guidantonio Malagoli Tagliazucchi⁶  Caterina Disisto⁵  Patrizia Celli⁷  Maurizio Ferrario⁸  Umberto Canosi⁸  Carlo Cernetti^1,10  Francesco Negri^1,10  Piera Angelica Merlini⁹  Marco Tubaro^1,12  Carlo Berzuini^1,13  Chiara Manzalini⁵  Gianfranco Ignone^1,14  Carlo Campana^1,15  Luigi Moschini^1,16  Elisabetta Ponte^1,17  Roberto Pozzi^1,18  Raffaela Fetiveau^1,19  Silvia Buratti⁵  Elvezia Maria Paraboschi^2,20  Rosanna Asselta^2,20  Andrea Botti⁵  Domenico Tuttolomondo⁵  Federico Barocelli⁵  Serena Bricoli⁵  Andrea Biagi⁵  Rosario Bonura⁵  Tiziano Moccetti^1,16  Antonio Crocamo⁵  Giorgio Benatti⁵  Giorgia Paoli⁵  Emilia Solinas⁵  Maria Francesca Notarangelo⁵  Elisabetta Moscarella^2,21  Paolo Calabrò^2,21  Stefano Duga^2,20  Giulia Magnani⁵  Diego Ardissino⁵ 

[1] Imperial College London;Duke Clinical Research Institute;South Australian Health and Medical Research Institute;Clinical and Epidemiological Research Unit, University Hospital of Parma;Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma;Department of Genetics, Evolution and Environment, UCL Genetics Institute, University College;Division of Cardiology, Ospedale San Camillo;Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo;Associazione per lo Studio della Trombosi in Cardiologia;Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”;Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda;ICCU, Intensive and Interventional Cardiology, San Filippo Neri Hospital;Centre for Biostatistics, School of Health Sciences, University of Manchester;Department of Cardiology, Antonio Perrino Hospital;Department of Cardiology, Sant'Anna Hospital;Division of Cardiology;Hospital Universitario de Toledo;Division of Cardiology, San Luigi Gonzaga University Hospital;Division of Cardiology, Ospedale di Legnano;Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University;University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania

关键词: gender;    long term outcomes;    baseline risk differences;    myocardial infarction;    young;   

DOI  :  10.3389/fcvm.2022.863811

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY