The impact of sex on the outcome of troponin-positive patients with non-obstructive coronary arteries: a retrospective cohort analysis

Fabienne Kreimer (Bochum)1, C. Schlettert (Bochum)2, M. Abumayyaleh (Mannheim)3, I. Akin (Mannheim)3, M. M. Hijazi (Dresden)4, N. Hamdani (Bochum)5, M. Gotzmann (Bochum)1, A. Mügge (Bochum)6, A. Aweimer (Bochum)7, I. El-Battrawy (Bochum)2

1Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland; 2Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 3Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; 4Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery Dresden, Deutschland; 5Kath. Klinikum Bochum Cellular Physiology Bochum, Deutschland; 6Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland; 7Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland


Background: Evidence on the impact of gender on the outcome of patients with myocardial infarction with non-obstructive coronary arteries is limited. The aim of this study was to investigate the prognostic impact of sex on in- and out-of-hospital adverse events in troponin-positive patients with non-obstructive coronary arteries.

Methods and Results: 24,775 patients who underwent coronary angiography from 2010 to 2021 in our hospital were screened for this study. The final study population consisted of 373 troponin-positive patients with non-obstructive coronary arteries, including 185 males and 188 females. The follow-up was 6.2 ± 3.1 years. The primary study end point was a composite of in-hospital adverse events, including stroke, cardiopulmonary resuscitation, cardiogenic shock, pulmonary oedema, invasive respiratory ventilation, left ventricular thrombus, thromboembolic events, life-threatening arrhythmias, supraventricular arrhythmias, and all-cause mortality. Secondary endpoints covered out-of-hospital adverse, including stroke, thromboembolic events, recurrence of troponin-positive with non-obstructive coronary arteries, percutaneous coronary intervention, cardiac arrest, and all-cause mortality.
Men were significantly younger than women (59±17 years vs. 67±12 years, p<0.001), more likely to present with ST-segment elevation (21.1% vs. 8.5%, p<0.001) and were more likely to have a smoking history (30.6% vs. 15.7%, p<0.001). Women were significantly more likely to have malignant disease (16.1% vs. 9.2%, p=0.047). In-hospital adverse event rates revealed no significant sex differences (37.8% in males vs. 33% in females, p=0.326) (Figure 1). Significantly more long-term adverse events occurred in women compared with men during follow-up (27.3% vs. 41.9%) (Figure 2). All-cause mortality was significantly higher in women than in men (29.7% vs. 21.2%, p=0.022), with no significant difference in death from cardiac causes (1.7% vs. 2.5%, p=1.000), but from non-cardiac causes (8.6% vs. 1.7%, p=0.019). Cox analysis identified age ≥70 years, arterial hypertension, diabetes mellitus, supraventricular tachycardia, pulmonary disease, neurological disease, and kidney disease as predictors of out-of-hospital adverse events, whereas male sex was associated with a better long-term outcome.

Conclusions: While gender differences were not significant in in-hospital adverse events, females demonstrated a higher incidence of out-of-hospital adverse events and increased mortality during long-term follow-up compared to males. Both cardiovascular and non-cardiovascular comorbidities significantly impair the outcome after myocardial infarction with non-obstructive arteries.

Figure 1: Rate of in-hospital adverse events in males and females

Figure 2: Kaplan Meier survival analysis for out-of-hospital adverse events in males versus females

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