Abstract
Aims and Objectives. We investigate sex disparities in management and outcomes of myocardial infarction (MI) in contemporary practice in Scotland.
Methods. This was a longitudinal cohort study including all MI admissions across Scotland between 2010-2016 and 2:1 age, sex, and GP practice-matched general population controls. Participants were followed up until end of 2021. We analysed in-hospital outcomes (percutaneous coronary intervention (PCI), mortality) using Poisson regressions, adjusting for age, co-morbidities and ST-elevation. We used Royston-Parmar models for long-term outcomes (all-cause and cardiovascular mortality, incident cardiovascular events) adjusting for age, comorbidities, and secondary prevention.
Results. Of a total 47,063 MI patients, 15,776 (33.5%) were women. Median (interquartile range) age was 66 (57,73) years. Compared to men, women were older and more comorbid, but were less likely to undergo PCI (risk ratio (95% confidence interval) - 0.87 (0.86-0.89)) or receive secondary prevention at discharge (0.94 (0.93-0.95)). No in-hospital mortality difference was observed between sexes (1.06 (0.99-1.13) after adjustment). Over a median follow-up of 8.2 (6.7,10.1) years, women had higher crude rates of adverse outcomes. After full adjustment, this translated into lower risk for women compared to men of all-cause mortality (hazard ratio 0.92 (0.89-0.95)), cardiovascular mortality (0.82 (0.78-0.87)), cardiovascular events (0.92 (0.88-0.95)). The female survival advantage seen in general population controls was attenuated in MI patients.
Conclusions. Women were undertreated compared to men after MI. Their survival and outcome benefit may be improved further. Poor outcomes in men despite better receipt of secondary prevention require further attention
Methods. This was a longitudinal cohort study including all MI admissions across Scotland between 2010-2016 and 2:1 age, sex, and GP practice-matched general population controls. Participants were followed up until end of 2021. We analysed in-hospital outcomes (percutaneous coronary intervention (PCI), mortality) using Poisson regressions, adjusting for age, co-morbidities and ST-elevation. We used Royston-Parmar models for long-term outcomes (all-cause and cardiovascular mortality, incident cardiovascular events) adjusting for age, comorbidities, and secondary prevention.
Results. Of a total 47,063 MI patients, 15,776 (33.5%) were women. Median (interquartile range) age was 66 (57,73) years. Compared to men, women were older and more comorbid, but were less likely to undergo PCI (risk ratio (95% confidence interval) - 0.87 (0.86-0.89)) or receive secondary prevention at discharge (0.94 (0.93-0.95)). No in-hospital mortality difference was observed between sexes (1.06 (0.99-1.13) after adjustment). Over a median follow-up of 8.2 (6.7,10.1) years, women had higher crude rates of adverse outcomes. After full adjustment, this translated into lower risk for women compared to men of all-cause mortality (hazard ratio 0.92 (0.89-0.95)), cardiovascular mortality (0.82 (0.78-0.87)), cardiovascular events (0.92 (0.88-0.95)). The female survival advantage seen in general population controls was attenuated in MI patients.
Conclusions. Women were undertreated compared to men after MI. Their survival and outcome benefit may be improved further. Poor outcomes in men despite better receipt of secondary prevention require further attention
| Original language | English |
|---|---|
| Journal | European Journal of Preventive Cardiology |
| DOIs | |
| Publication status | Accepted/In press - 3 Oct 2024 |
Bibliographical note
ACKNOWLEDGEMENTSWe would like to thank Dr Graham Horgan, PhD (Principal Consultant for Human Health and Nutrition, Biomathematics & Statistics Scotland), for his help and support with the statistical analyses. We would also like to thank the funder (NHS Grampian Endowment Fund) for their financial support to perform the study. The authors would also like to acknowledge the support of the eDRIS Team (Public Health Scotland) for their involvement in obtaining approvals, provisioning and linking data and the use of the secure analytical platform within the National Safe Haven. We would also like to acknowledge the support received from the Ageing Clinical and Experimental Research Patient and Public Involvement Group for their help with developing the study protocol and discussing and disseminating the results.
Keywords
- Myocardial infarction
- Sex
- mortality
- cardiovascular
- outcomes
- Scotland