Objectives:
Sex differences are known to exist in the management ofolder patients presenting with myocardial infarction (MI). Whether inpatient MI management, outcomes and readmissions differ by sex in young adults is not known.
Methods:
Nationwide Readmissions Database (NRD) was queried for hospitalizations with MI in adults between 18 and 50 years of age from October 2015 and November 2016 using ICD-10 CM codes. Hospitalizations with discharges in December were excluded as 30-day follow-up for these could not be completed in NRD. Logistic regression analysis was used to estimate the association between gender and percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), coronary angiography, non-invasive testing, death and 30-day readmissions. ST-elevation MI (STEMI) subset was similarly analyzed.
Results:
Of 33,981 hospitalizations, 29% were females. Mean age was 43 years. STEMI constituted 13,177 hospitalizations with 22% females. As compared with men, women were more likely to have peripheral vascular disease (6% vs 4%), chronic pulmonary disease (17% vs 10%), diabetes mellitus (36% vs 28%); and less likely to have a prior history of MI (10% vs 12%). Women were less likely to undergo noninvasive testing (10% vs 11 %, p=0.002) and were revascularized less often than men with PCI (45% vs 56%, p<0.0001) and CABG (6% vs 7%, p<0.0001). Women underwent PCI less often in STEMI as well (72% vs. 76%, p<0.0001). Inpatient mortality and 30-day readmissions were higher in women overall (1.9% vs 1.6%, p=0.04) and (14% vs 9%, p<0.0001); as well as in STEMI: (4% vs 3%, p<0.0001) and (12% vs 8%, p<0.0001). In adjusted analysis (Figure 1: A, B), women were less likely to undergo non-invasive testing or revascularization in the overall cohort; and were less likely to undergo PCI in the STEMI cohort. Additionally, women had higher odds of 30-day readmissions overall, while the odds of inpatient mortality were higher only in STEMI subset.
Conclusion:
In a large MI cohort, young women were less likely to undergo ischemic workup and be revascularized, and had higher odds of 30-day readmissions. Women had higher odds of mortality in STEMI
Sex differences in the non-invasive risk stratification and prognosis after myocardial infarction
