AUTHOR=Ardissino Maddalena , Nelson Adam J. , Maglietta Giuseppe , Malagoli Tagliazucchi Guidantonio , Disisto Caterina , Celli Patrizia , Ferrario Maurizio , Canosi Umberto , Cernetti Carlo , Negri Francesco , Merlini Piera Angelica , Tubaro Marco , Berzuini Carlo , Manzalini Chiara , Ignone Gianfranco , Campana Carlo , Moschini Luigi , Ponte Elisabetta , Pozzi Roberto , Fetiveau Raffaela , Buratti Silvia , Paraboschi Elvezia Maria , Asselta Rosanna , Botti Andrea , Tuttolomondo Domenico , Barocelli Federico , Bricoli Serena , Biagi Andrea , Bonura Rosario , Moccetti Tiziano , Crocamo Antonio , Benatti Giorgio , Paoli Giorgia , Solinas Emilia , Notarangelo Maria Francesca , Moscarella Elisabetta , Calabrò Paolo , Duga Stefano , Magnani Giulia , Ardissino Diego TITLE=Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.863811 DOI=10.3389/fcvm.2022.863811 ISSN=2297-055X ABSTRACT=Importance

There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure.

Methods

A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1–22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).

Results

ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52–0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up.

Conclusions

There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes.

Trial Registration

4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.