Impact of sex on the outcome of troponin-positive patients with non-obstructive coronary arteries

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a complex clinical entity characterized by symptoms suggestive of acute coronary syndrome, elevated troponin levels, and nonobstructive coronary arteries on angiography. There is limited evidence on the impact of gender on the outcome of MINOCA patients. The aim of this study was to investigate the prognostic impact of sex on intra- and out-of-hospital adverse events and long-term outcome in patients with troponin-positive and non-obstructive coronary artery disease (CAD).

Methods and Results: 24,775 patients who underwent coronary angiography from 2010 to 2021 were screened for this study. The final study population consisted of 373 patients with a follow-up period of 6.2 ± 3.1 years who were initially presenting troponin-positive with non-obstructive CAD, with 185 males and 188 females. 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 long-term adverse events during follow-up, 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), more likely to present electrocardiographically with ST-segment elevation on admission (21.1% vs. 8.5%) and were more likely to have a smoking history (30.6% vs. 15.7%). Women were significantly more likely to have malignant disease (16.1% vs. 9.2%). No significant sex differences were observed in medication prescribing at discharge. In-hospital adverse event rates revealed no significant sex differences. Significantly more long-term adverse events occurred in women compared with men during follow-up (27.3% vs. 41.9%). All-cause mortality was significantly higher in women than in men (29.7% vs. 21.2%, p=0.022), with death from cardiac causes (1.7% vs. 2.5%, p=1.000) and 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 long-term adverse events, whereas male sex was associated with a better long-term outcome.

Conclusion: While gender differences were not significant in in-hospital complications, females demonstrated a higher incidence of adverse events and increased mortality during long-term follow-up compared to males.