1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland
Introduction: While acute ST-elevation-myocardial infarctions (STEMI) in women before menopause are relatively rare, higher rates of atypical symptoms and higher short- and long-term-adverse event rates are often reported for women. However, women are on average older than men during the index events and their higher age might impact likelihood of atypical events and mortality rates. Aim of the present study was to compare women <55 years of age with STEMI to age matched men and to investigate the impact of gender on symptom presentation, infarction characteristics and short- and long-term outcome.
Methods: Patients <55 years of age with STEMI, admitted between 2006 and 2022 to a large PCI center were included in the analysis and women were compared to men. To exclude regional bias a control group was established comparing the entire STEMI-cohort (women vs. men). Outcome results were presented in unadjusted and multivariate adjusted data.
Results: Of a total of 12094 patients in the total cohort 3343 (28%) were women and 8751 (72%) were men, with a mean age of 69.7±13 yrs. in women and 62.2±12 in men. Women were less likely to present without typical chest pain compared to men (12.0% vs. 8.5%, p<0.01) and more likely to present with dyspnea (26.1% vs. 22.7% p<0.01). When however focusing only on patients <55 yrs. of age (515 women (16.5%), 2594 men (83.5%)) mean age was similar between women and men (47.2±5.9 yrs. vs 47.5±5.5 47.5±5.5 yrs., p=0.26). Furthermore, women <55 yrs. had similar rates of absence of chest pain (5.7% vs. 5.4%, p=0.79) and similar rates of dyspnea (19.9% vs. 18.5%, p=0.45) compared to men, while rates of delayed STEMI-presentation were lower in women (8.3% vs. 10.9%, p=0.07). While women showed lower rates of multi-vessel-disease (women 37.1%, men 50.4%, p<0.01) unadjusted data showed that women <55 yrs. had a more than 60% higher 30-day and 1-year-mortality after STEMI compared to men (table, left side). This disadvantage for women remained in a multivariate model (table, right side). In a subgroup analysis, higher-1-year-mortality-rates for women were still evident when stratifying by presence of chest pain (with chest patin: women 5.9%, men 3.8%, p=0.06, w/o chest pain: women 34.7% vs. men 19.6%, p=0.38) or when excluding patients with delayed STEMI-presentations (women 7.5%, men 4.9%, p=0.04).
Table: Short- and longterm outcome in STEMI-patients<55 yrs: women compared to men
| Unadjusted analysis | Adjusted analysis* | |||||
| 30-day-mortality | 1-year mortality | Multivariate model (women vs. men) | 30-day-mortality | 1-year mortality | ||
| Women (%) | 6.9 | 8.7 | Adjusted OR | 2.02 | 1.85 | |
| Men (%) | 4.2 | 5.2 | 95% CI | 1.1-3.6 | 1.1-3.1 | |
| p | 0.017 | <0.01 | p | 0.018 | 0.017 | |
*Adjusted for BMI, diabetes, smoking, atypical symptoms, anterior STEMI, shock, single vessel disease, intervention
Conclusions: While only 16.5% of all STEMI-patients younger 55 years of age were women they showed a more than 60% higher short- and long-term-mortality compared to their male peers. This disadvantage, at least with our data, cannot be sufficiently explained by higher rates of delayed STEMI-presentations or abscence of typical chest pain. Further studies are needed to identify possible causes for this higher vulnerability of non-post-menopausal women to acute myocardial infarctions.