Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction
Copyright © 2022 Ardissino, Nelson, Maglietta, Malagoli Tagliazucchi, Disisto, Celli, Ferrario, Canosi, Cernetti, Negri, Merlini, Tubaro, Berzuini, Manzalini, Ignone, Campana, Moschini, Ponte, Pozzi, Fetiveau, Buratti, Paraboschi, Asselta, Botti, Tuttolomondo, Barocelli, Bricoli, Biagi, Bonura, Moccetti, Crocamo, Benatti, Paoli, Solinas, Notarangelo, Moscarella, Calabrò, Duga, Magnani and Ardissino..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:9 |
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| Enthalten in: |
Frontiers in cardiovascular medicine - 9(2022) vom: 16., Seite 863811 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Baseline risk differences |
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| Anmerkungen: |
Date Revised 22.07.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3389/fcvm.2022.863811 |
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| Förderinstitution / Projekttitel: |
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NLM343796252 |
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| 520 | |a Copyright © 2022 Ardissino, Nelson, Maglietta, Malagoli Tagliazucchi, Disisto, Celli, Ferrario, Canosi, Cernetti, Negri, Merlini, Tubaro, Berzuini, Manzalini, Ignone, Campana, Moschini, Ponte, Pozzi, Fetiveau, Buratti, Paraboschi, Asselta, Botti, Tuttolomondo, Barocelli, Bricoli, Biagi, Bonura, Moccetti, Crocamo, Benatti, Paoli, Solinas, Notarangelo, Moscarella, Calabrò, Duga, Magnani and Ardissino. | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a Trial Registration: 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a baseline risk differences | |
| 650 | 4 | |a gender | |
| 650 | 4 | |a long term outcomes | |
| 650 | 4 | |a myocardial infarction | |
| 650 | 4 | |a young | |
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