Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry
Abstract Aims There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at...
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| Veröffentlicht in: | European heart journal 2020-11, Vol.41 (42), p.4127-4137 |
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| creator | DeFilippis, Ersilia M Collins, Bradley L Singh, Avinainder Biery, David W Fatima, Amber Qamar, Arman Berman, Adam N Gupta, Ankur Cawley, Mary Wood, Malissa J Klein, Josh Hainer, Jon Gulati, Martha Taqueti, Viviany R Di Carli, Marcelo F Nasir, Khurram Bhatt, Deepak L Blankstein, Ron |
| description | Abstract
Aims
There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age.
Methods and results
Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P |
| doi_str_mv | 10.1093/eurheartj/ehaa662 |
| format | Article |
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Aims
There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age.
Methods and results
Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61).
Conclusions
Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehaa662</identifier><identifier>PMID: 33049774</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Clinical Research ; Coronary Angiography ; Coronary Artery Disease ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Infarction - therapy ; Registries ; Risk Factors ; Sex Factors ; Treatment Outcome</subject><ispartof>European heart journal, 2020-11, Vol.41 (42), p.4127-4137</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-5a3fc19806eabecdd369023ffde333606415a877c8b1bc81899979358ebf529b3</citedby><cites>FETCH-LOGICAL-c436t-5a3fc19806eabecdd369023ffde333606415a877c8b1bc81899979358ebf529b3</cites><orcidid>0000-0001-6994-8199 ; 0000-0003-1717-005X ; 0000-0002-0812-5890 ; 0000-0002-2380-9756 ; 0000-0002-0136-3781 ; 0000-0002-0610-5028 ; 0000-0002-1278-6245 ; 0000-0002-0724-9779</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33049774$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DeFilippis, Ersilia M</creatorcontrib><creatorcontrib>Collins, Bradley L</creatorcontrib><creatorcontrib>Singh, Avinainder</creatorcontrib><creatorcontrib>Biery, David W</creatorcontrib><creatorcontrib>Fatima, Amber</creatorcontrib><creatorcontrib>Qamar, Arman</creatorcontrib><creatorcontrib>Berman, Adam N</creatorcontrib><creatorcontrib>Gupta, Ankur</creatorcontrib><creatorcontrib>Cawley, Mary</creatorcontrib><creatorcontrib>Wood, Malissa J</creatorcontrib><creatorcontrib>Klein, Josh</creatorcontrib><creatorcontrib>Hainer, Jon</creatorcontrib><creatorcontrib>Gulati, Martha</creatorcontrib><creatorcontrib>Taqueti, Viviany R</creatorcontrib><creatorcontrib>Di Carli, Marcelo F</creatorcontrib><creatorcontrib>Nasir, Khurram</creatorcontrib><creatorcontrib>Bhatt, Deepak L</creatorcontrib><creatorcontrib>Blankstein, Ron</creatorcontrib><title>Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Abstract
Aims
There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age.
Methods and results
Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61).
Conclusions
Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.</description><subject>Adult</subject><subject>Clinical Research</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - therapy</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Treatment Outcome</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUFv1DAQhS0EokvhB3BBPnIg1I4TJ-aABBUslVp6oQJO1sSZJK42cWo7XfZH8J8x2mUFNy4zh3nvmyc9Qp5z9pozJc5w8QOCj7dnOABImT8gK17meaZkUT4kK8ZVmUlZfzshT0K4ZYzVksvH5EQIVqiqKlbk51c34kS3g6P4Y0ZvcTJIgY47Z8C3FjbUTh14E62bKMR02rll6in0SAe4R7p1PiB1SzSJFGiaM3hs6dbGgSb2GxoHpFcQAl3jhD4R33vbDzDS79c3n9fZ1QX12NsQ_e4pedTBJuCzwz4lNx8_fDn_lF1ery_O311mphAyZiWIznBVM4nQoGlbIRXLRde1KISQTBa8hLqqTN3wxtS8VkpVSpQ1Nl2Zq0ackrd77rw0I7YGp5hy6dnbEfxOO7D638tkB927e11VjFWlTICXB4B3dwuGqEcbDG42MKFbgs6LknNR5TVPUr6XGu9C8Ngd33Cmf9eojzXqQ43J8-LvfEfHn96S4NVe4Jb5P3i_AIr0r0I</recordid><startdate>20201107</startdate><enddate>20201107</enddate><creator>DeFilippis, Ersilia M</creator><creator>Collins, Bradley L</creator><creator>Singh, Avinainder</creator><creator>Biery, David W</creator><creator>Fatima, Amber</creator><creator>Qamar, Arman</creator><creator>Berman, Adam N</creator><creator>Gupta, Ankur</creator><creator>Cawley, Mary</creator><creator>Wood, Malissa J</creator><creator>Klein, Josh</creator><creator>Hainer, Jon</creator><creator>Gulati, Martha</creator><creator>Taqueti, Viviany R</creator><creator>Di Carli, Marcelo F</creator><creator>Nasir, Khurram</creator><creator>Bhatt, Deepak L</creator><creator>Blankstein, Ron</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6994-8199</orcidid><orcidid>https://orcid.org/0000-0003-1717-005X</orcidid><orcidid>https://orcid.org/0000-0002-0812-5890</orcidid><orcidid>https://orcid.org/0000-0002-2380-9756</orcidid><orcidid>https://orcid.org/0000-0002-0136-3781</orcidid><orcidid>https://orcid.org/0000-0002-0610-5028</orcidid><orcidid>https://orcid.org/0000-0002-1278-6245</orcidid><orcidid>https://orcid.org/0000-0002-0724-9779</orcidid></search><sort><creationdate>20201107</creationdate><title>Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry</title><author>DeFilippis, Ersilia M ; Collins, Bradley L ; Singh, Avinainder ; Biery, David W ; Fatima, Amber ; Qamar, Arman ; Berman, Adam N ; Gupta, Ankur ; Cawley, Mary ; Wood, Malissa J ; Klein, Josh ; Hainer, Jon ; Gulati, Martha ; Taqueti, Viviany R ; Di Carli, Marcelo F ; Nasir, Khurram ; Bhatt, Deepak L ; Blankstein, Ron</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-5a3fc19806eabecdd369023ffde333606415a877c8b1bc81899979358ebf529b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Clinical Research</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - therapy</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DeFilippis, Ersilia M</creatorcontrib><creatorcontrib>Collins, Bradley L</creatorcontrib><creatorcontrib>Singh, Avinainder</creatorcontrib><creatorcontrib>Biery, David W</creatorcontrib><creatorcontrib>Fatima, Amber</creatorcontrib><creatorcontrib>Qamar, Arman</creatorcontrib><creatorcontrib>Berman, Adam N</creatorcontrib><creatorcontrib>Gupta, Ankur</creatorcontrib><creatorcontrib>Cawley, Mary</creatorcontrib><creatorcontrib>Wood, Malissa J</creatorcontrib><creatorcontrib>Klein, Josh</creatorcontrib><creatorcontrib>Hainer, Jon</creatorcontrib><creatorcontrib>Gulati, Martha</creatorcontrib><creatorcontrib>Taqueti, Viviany R</creatorcontrib><creatorcontrib>Di Carli, Marcelo F</creatorcontrib><creatorcontrib>Nasir, Khurram</creatorcontrib><creatorcontrib>Bhatt, Deepak L</creatorcontrib><creatorcontrib>Blankstein, Ron</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DeFilippis, Ersilia M</au><au>Collins, Bradley L</au><au>Singh, Avinainder</au><au>Biery, David W</au><au>Fatima, Amber</au><au>Qamar, Arman</au><au>Berman, Adam N</au><au>Gupta, Ankur</au><au>Cawley, Mary</au><au>Wood, Malissa J</au><au>Klein, Josh</au><au>Hainer, Jon</au><au>Gulati, Martha</au><au>Taqueti, Viviany R</au><au>Di Carli, Marcelo F</au><au>Nasir, Khurram</au><au>Bhatt, Deepak L</au><au>Blankstein, Ron</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2020-11-07</date><risdate>2020</risdate><volume>41</volume><issue>42</issue><spage>4127</spage><epage>4137</epage><pages>4127-4137</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Aims
There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age.
Methods and results
Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61).
Conclusions
Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>33049774</pmid><doi>10.1093/eurheartj/ehaa662</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-6994-8199</orcidid><orcidid>https://orcid.org/0000-0003-1717-005X</orcidid><orcidid>https://orcid.org/0000-0002-0812-5890</orcidid><orcidid>https://orcid.org/0000-0002-2380-9756</orcidid><orcidid>https://orcid.org/0000-0002-0136-3781</orcidid><orcidid>https://orcid.org/0000-0002-0610-5028</orcidid><orcidid>https://orcid.org/0000-0002-1278-6245</orcidid><orcidid>https://orcid.org/0000-0002-0724-9779</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal, 2020-11, Vol.41 (42), p.4127-4137 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Clinical Research Coronary Angiography Coronary Artery Disease Female Humans Male Middle Aged Myocardial Infarction - epidemiology Myocardial Infarction - therapy Registries Risk Factors Sex Factors Treatment Outcome |
| title | Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry |
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