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Sex Difference in Outcomes of Acute MI in Young Patients
Quick Takes
- In the year after acute myocardial infarction, young women (aged 18-55 years) have higher rates of rehospitalization than young men.
- Rehospitalization is most commonly related to cardiac events in both women and men; however, women had higher rates of rehospitalization for both cardiac- and noncardiac-related events.
Study Questions:
Do younger women (aged 18-55 years) have higher risk of cardiovascular and noncardiovascular hospitalizations in the year after acute myocardial infarction (AMI)?
Methods:
This analysis used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled patients aged 18-55 years across 103 hospitals (2008–2012). Sex differences in all-cause and cause-specific hospitalizations were assessed. Differences in hospitalizations were compared with incidence rates (IRs) (IR per 1,000 person-years) and IR ratios with 95% confidence interval (CI), and sex differences were assessed using sub-distribution hazard ratios (SHRs) accounting for deaths.
Results:
Of 2,979 participants, 2,007 were women, 972 were men, mean age was 47.1 ± 6.2 years, 17.5% self-identified as non-Hispanic Black, and 70% as non-Hispanic White. Median duration of follow-up was 365 days. After AMI, 30.4% had at least one hospitalization in the following year. Most hospitalizations were related to coronary events (IR, 171.8; 95% CI, 153.6-192.2 among women vs. IR, 117.8; 95% CI, 97.3-142.6 among men). Noncardiac hospitalization rates were IR, 145.8; 95% CI, 129.2-164.5 among women vs. IR, 69.6; 95% CI, 54.5-88.9 among men. Women had higher rates of hospitalizations with the calculated SHR of 1.33 (95% CI, 1.04-1.70; p = 0.02) for coronary-related and 1.51 (95% CI, 1.13-2.07; p = 0.01) for noncardiac hospitalizations.
Conclusions:
In the year following AMI, the authors concluded that young women had higher rates of hospitalizations than young men, and the difference in noncardiac hospitalizations was most significant.
Perspective:
Prior studies have shown that young women have worse health status than young men after AMI. This study adds to our understanding by showing that rehospitalization rates in the year following AMI are higher for young women, especially for noncardiac reasons. In order to improve overall cardiovascular care for young women, future studies need to determine the various underlying medical, systemic, and psychosocial reasons for noncardiac hospitalizations.
Clinical Topics: Acute Coronary Syndromes, Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD and Pediatrics and Arrhythmias
Keywords: Acute Coronary Syndrome, Hospitalization, Myocardial Infarction, Patient Readmission, Secondary Prevention, Sex Characteristics, Women, Young Adult
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