Trends of Sex Differences in Clinical Outcomes After Myocardial Infarction in the United States

Andrija Matetic, Warkaa Shamkhani, Muhammad Rashid, Annabelle Santos Volgman, Harriette G C Van Spall, Thais Coutinho, Laxmi S Mehta, Garima Sharma, Purvi Parwani, Mohamed Osama Mohamed, Mamas A Mamas, Andrija Matetic, Warkaa Shamkhani, Muhammad Rashid, Annabelle Santos Volgman, Harriette G C Van Spall, Thais Coutinho, Laxmi S Mehta, Garima Sharma, Purvi Parwani, Mohamed Osama Mohamed, Mamas A Mamas

Abstract

Background: Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time.

Methods: Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ2 test was performed to examine the trend of management and in-hospital outcomes over the study period.

Results: Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; P < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events.

Conclusions: In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them.

© 2021 The Authors.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Adjusted odds ratios (aORs) of invasive management and in-hospital adverse outcomes in women (reference group is men). CA, coronary angiography; CI, confidence interval; MACCE, major adverse cardiac and cerebrovascular events (composite of mortality, acute stroke/transient ischemic attack and cardiac complications); PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Receipt of invasive management according to sex from 2004 to September 31, 2015. P < 0.001 for all trends. CA, coronary angiography; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
In-hospital adverse outcomes according to sex from 2004 to September 31, 2015. P < 0.001 for all trends. MACCE, major adverse cardiac and cerebrovascular events (composite of mortality, acute stroke/transient ischemic attack and cardiac complications).

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