Introduction:
There are important sex differences in the pathophysiology and clinical presentation of cardiovascular disease. Cardiovascular disease is understudied in women, despite it being the leading cause of mortality. The goal of this study is to report sex differences in clinical characteristics, treatment, and outcomes in young patients presenting with acute myocardial infarction.
Methods:
This is a retrospective observational study that included patients ages 18 to 40 hospitalized for acute myocardial infarction between 2006 and 2016 in Kaiser Permanente Southern California, a large integrated healthcare system. Differences in demographics, clinical characteristics, and management were examined between men and women. Multivariable Cox proportional hazard models were used to examine the association between sex and mortality.
Results:
Between 2006 and 2016, a total of 26,390 patients were hospitalized with a principal diagnosis of acute myocardial infarction and underwent coronary catheterization. In this cohort, 603 patients were young adults between age 18 to 40, of whom 144 (24%) were women. Women were more likely to be black. There were no significant sex differences in the prevalence of hypertension, hyperlipidemia, diabetes, heart failure and renal failure. There was a higher prevalence of obesity in women. Women were more likely to have no obstructive disease on coronary angiogram (43.4% vs. 33.2%, p=0.03). Treatment with percutaneous coronary intervention was less likely in women (38.2% vs. 56.2%, p<0.001). Mortality was low for both women and men during index hospitalization (0.7% vs 0.9%, p=0.84) and at one year (1.4% vs. 1.5%, p=0.91), with no significant differences (adjusted HR 1.3, 95% CI 0.5-3.1).
Conclusions:
Compared to young men, young women presenting with acute myocardial infarction as less likely to have obstructive coronary artery disease. Mortality rates for both men and women were low, with no significant differences observed.
Sex Differences in Clinical Characteristics, Hospital Management Practices, and In-Hospital Outcomes in Patients Hospitalized in a Vietnamese Hospital with a First Acute Myocardial Infarction
