Young women who experience a myocardial infarction (MI) have more adverse outcomes and are more likely to end up back in the hospital compared to men of a similar age in the year following discharge, according to a study published May 1 in JACC.

Mitsuaki Sawano, MD, PhD, et al., used data from the VIRGO study, an observational study of the presentation, treatment and outcomes of young women and men who experienced a MI between ages 18 and 55 years old. In the current study, after excluding in-hospital deaths, the final cohort included 2,979 patients hospitalized for MI (2,007 women vs. 972 men). The study examined all-cause and cause-specific acute events that required hospitalization, which was defined as any hospital or observation stay longer than 24 hours within one year of discharge following MI. The average age was 47 years and 70% self-identified as non-Hispanic White. A high proportion of women self-identified as non-Hispanic Black compared to men. Women also had a higher prevalence of comorbidities, including obesity, congestive heart failure, prior stroke and renal disease. In the patient cohort, the young women were more likely to be low-income, have a history of depression and significantly worse health status compared to men in the study.

Results showed that women were less likely to present to the hospital with chest pain and more likely to arrive more than six hours after symptom onset. They were also more likely to have a NSTEMI or a MI with nonobstructive coronary arteries (MINOCA). The women experiencing MINOCA were younger, more likely to be a non-Hispanic Black patient, smoker, with a lower education status and the lowest proportion of previous coronary artery disease. These patients also reported lower treatment satisfaction compared with men or women presenting with myocardial infarction with obstructive coronary artery disease (MI-CAD). On average, women stayed in the hospital longer and received lower rates of guideline-recommended medical therapies including aspirin, statins, beta-blockers and ACE inhibitors.

All-cause hospitalization rates within one year of discharge were 34.8% for women and 23% for men. The leading cause of hospitalizations for women were coronary-related, followed by noncardiac then other cardiac and stroke-related hospitalizations. Women with MINOCA had lower rates of one-year outcomes compared with women who experienced MI-CAD. There was a more significant sex disparity between women and men for noncardiac hospitalizations compared to all other hospitalizations (145.8 vs. 69.6 per 1,000 person-years).

"We think that the accumulation of risk factors seen in the MI-CAD population is associated with the high incidence of hospitalization one year after heart attack," Sawano said. "We must emphasize, however, that does not mean that MINOCA patients are 'low risk.' We know from recent studies that MINOCA is not a benign disease compared with similarly aged women and these cases warrant further evaluation to understand the underlying mechanism and treatment of certain conditions."

The researchers conclude that their findings demonstrate the need for continued efforts to optimize secondary preventive strategies to reduce coronary-related hospitalizations, but also highlight the need for further research into the causes and mechanisms of noncardiac hospitalization especially given the significant sex disparity.

In an accompanying editorial, Martha Gulati, MD, MS, FACC, et al., said, "This study importantly identifies an increased rate of cardiovascular and non-cardiovascular rehospitalization in women as compared to men, with a clear association between psychosocial and demographic factors. Yet the root cause of sex differences in psychosocial factors and rates of comorbid conditions remains elusive. Why are more women than men identified as low income in this cohort? Why does this cohort demonstrate a nearly two-fold greater prevalence of depression in women as compared to men? As a cardiovascular community, by continuing to ask why perhaps we can arrive at 'what next.'"

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Chronic Angina

Keywords: Coronary Artery Disease, Non-ST Elevated Myocardial Infarction, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Incidence, Patient Discharge, Patient Readmission, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Sex Characteristics, Hospital Mortality, Depression

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