In a new study of younger patients hospitalized with acute myocardial infarction (AMI), investigators found disparities in clinical outcomes still exist between men and women.
Findings published in the Canadian Journal of Cardiology showed that although mortality rates after AMI were similar between the sexes, cardiovascular readmission rates and all-cause readmissions were significantly increased among women.
“Many care gaps are closing for younger women with AMI in Ontario, but readmission rates remain higher than for younger men,” said lead author Mina Madan, MD, MHS, of the Department of Medicine, University of Toronto, Toronto, ON, Canada, in a press statement.
To determine if disparities continue to exist in processes of care and clinical outcomes, Madan and colleagues studied patients with AMI aged 18-55 years who were hospitalized from April 1, 2009, to March 31, 2019, in Ontario. Investigators compared trends in comorbidities, angiographic findings, and revascularization rates in men and women. The primary outcome was 1-year all-cause mortality or readmission for unstable angina, AMI, heart failure, or stroke.
Among the 38 071 patients with AMI included in the analysis, 8077 (21.2%) were women.
Researchers found that women had increasing rates of diabetes over the study period, going from 24.8% in 2009 to 34.9% in 2018. In contrast, the rates of diabetes among men increased from 18.2% in 2009 to 22.1% in 2018. Current smoking significantly decreased in both women and men during this time as well (women: 53.2% in 2009 to 41.7% in 2018; men: 52.7% to 43.3%), according to the study results.
Although most patients (96%) received coronary angiography, coronary revascularization was less frequent among women than men (percutaneous coronary intervention [PCI]: 61.9% vs 78.8% [P<.001]; surgery: 4.1% vs 6.0% [P<.001]).
“The lower rate of PCI among younger women may reflect increasing recognition of alternative pathophysiology for AMI among women in this age group,” noted Madan et al.
Women had more normal coronary anatomy than men (5.8% vs 1.7%; P<.001) and higher nonobstructive disease (22.8% vs 9.3%; P<.001) than men, added researchers.
Compared with men, the primary composite endpoint was significantly increased among women (10.0% vs 7.9%; adjusted hazard ratio [aHR], 1.11; P=.02) and was related to increased readmission rates for cardiovascular events. Furthermore, all-cause hospital readmission was significantly higher among women than men (25.8% vs 21.1%, aHR, 1.34; P<.001).
“This may reflect the higher risk profile we observed among younger women in our study compared with younger men or support the notion that younger women may benefit from earlier follow-up care and better support networks that could reduce the need for readmissions soon after discharge,” concluded Madan in the release.
Reference: Madan M, Qui F, Sud M, et al. Clinical outcomes in younger women hospitalized with an acute myocardial infarction: A contemporary population-level analysis. Canadian Journal of Cardiology. Published online October 4, 2022. doi:10.1016/j.cjca.2022.06.023