Sex differences in outcomes in patients with acute myocardial infarction.

OBJECTIVE

Gender is a vital factor for the development and treatment of cardiovascular diseases. This study aimed to evaluate sex-based differences in the prognosis of patients with acute myocardial infarction (AMI).

METHODS

AMI patients who had been registered in the MIMIC III and IV database were enrolled. The primary study endpoint was 1-year all-cause mortality. The secondary study endpoints were in-hospital all-cause mortality, 28-day all-cause mortality, in-hospital complications of acute kidney injury (AKI) and ventricular arrhythmias (VA). Kaplan-Meier analysis was used to assess survival rate between the two groups. Cox proportional hazards regression and logistic regression analyses were performed to evaluate whether gender is an independent predictor of prognosis of AMI patients.

RESULTS

A total of 4890 patients with AMI were included. At 1-year follow-up, 722 (22.5%) men died and 558 (33.2%) women died, and after analysis and adjustment, men had a 17.9% lower risk of all-cause mortality compared to women [Hazard Ratio (HR) = 0.821, 95% confidence interval (CI): 0.684-0.987]. Kaplan-Meier survival analysis showed a higher 1-year survival rate in the male group compared with the female group (HR = 0.532, 95% CI: 0.444-0.638, log-rank P < 0.0001). There was no significant difference in AKI during hospitalization. After adjusting for multivariable analysis, men with AMI had a 25% increased risk of hospitalization for VA compared to women [odds ratio (OR) = 1.250, 95% CI:1.030-1.518].

CONCLUSION

Women had a higher 1-year mortality but a lower risk of ventricular arrhythmias (VA) during AMI compared to men.

CLINICAL TRIAL APPROVAL STATEMENT: This Trial was registered in the Chinese clinical trials registry: ChiCTR1800014583. Registered 22 January 2018 ( http://www.chictr.org.cn/searchproj.aspx ).