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