Journal
HEART
Volume 107, Issue 18, Pages 1480-1486Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/heartjnl-2021-319118
Keywords
myocardial infarction; acute coronary syndrome; risk factors
Categories
Funding
- Swedish Foundation of Strategic Research
- Health Data Research UK
- HDR UK Ltd by the UK Medical Research Council [HDR-5012]
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council, Department of Health and Social Care (England)
- Chief Scientist Office of the Scottish Government Health and Social Care Directorates
- Health and Social Care Research and Development Division (Welsh Government)
- Public Health Agency (Northern Ireland)
- British Heart Foundation
- Wellcome Trust
- British Heart Foundation [FS/16/14/32023, RG/20/10/34966, RE/18/5/34216]
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This study found significant sex differences in clinical characteristics, investigations, and outcomes in patients with type 2 myocardial infarction. Despite higher risk of death in patients with type 2 MI compared to type 1 MI, women with type 2 MI were less likely to have obstructive coronary artery disease or severe left ventricular impairment, and had a higher survival rate than men.
Objectives Type 2 myocardial infarction (MI) is a heterogenous condition and whether there are differences between women and men is unknown. We evaluated sex differences in clinical characteristics, investigations and outcomes in patients with type 2 MI. Methods In the Swedish Web based system for Enhancement and Development of Evidence based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we compared patients admitted to coronary care units with a diagnosis of type 1 or type 2 MI. Sex-stratified Cox regression models evaluated the association with all-cause death in men and women separately. Results We included 57 264 (median age 73 years, 65% men) and 6485 (median age 78 years, 50% men) patients with type 1 and type 2 MI, respectively. No differences were observed in the proportion of men and women with type 2 MI who underwent echocardiography and coronary angiography, but women were less likely than men to have left ventricular (LV) impairment and obstructive coronary artery disease (CAD). Compared with type 1 MI, patients with type 2 MI had higher risk of death regardless of sex (men: adjusted HR 1.55 (95% CI 1.44 to 1.67); women: adjusted HR 1.34 (95% CI 1.24 to 1.45)). In those with type 2 MI, the risk of death was lower for women than men (adjusted HR 0.85 (95% CI 0.76 to 0.92) (men, reference)). Conclusions Type 2 MI occurred in men and women equally and we found no evidence of sex bias in the selection of patients for cardiac investigations. Patients with type 2 MI had worse outcomes, but women were less likely to have obstructive CAD or severe LV impairment and were more likely to survive than men.
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