Sex differences in investigations and outcomes among patients with type 2 myocardial infarction

Dorothea Kimenai, Bertil Lindahl, Andrew R Chapman, Tomasz Baron, Anton Gard, Ryan Wereski, Steven Meex, Tomas Jernberg, Nicholas L Mills, Kai Eggers

Research output: Contribution to journalArticlepeer-review

Abstract

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 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 6,485 (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 to type 1 MI, type 2 MI patients had higher risk of death regardless of sex (men, adjusted HR: 1.55 [95% CI,1.44-1.67]; women, adjusted HR: 1.34 [95% CI,1.24-1.45]). In those with type 2 MI the risk of death was lower for women than men (adjusted HR 0.85, 95% CI,0.76-0.92 [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. Type 2 MI patients had worse outcomes, but women were less likely to have obstructive CAD or severe LV impairment and were more likely to survive than men.
Original languageEnglish
JournalHeart
Early online date21 Apr 2021
DOIs
Publication statusE-pub ahead of print - 21 Apr 2021

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