- Among 204 men and 155 women at Massachusetts General Hospital who had type 2 myocardial infarction (T2MI), women were as likely as the men to undergo echocardiography, stress tests, angiography, percutaneous interventions and bypass surgery
- Women were less likely than men to be discharged on antiplatelet therapy; however, new prescriptions of antiplatelet agents were similar, as were prescriptions of beta-blockers and statins
- Despite a higher prevalence of cardiovascular comorbidities in men, 90-day readmission and mortality rates for T2MI were similar among men and women
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In October 2017, the International Classification of Diseases began recognizing type 2 myocardial infarction (T2MI) as a distinct diagnosis. T2MI (supply/demand mismatch) is a frequent cause of myocardial injury and has a grave prognosis; 20% of patients do not survive more than one year.
Cian P. McCarthy, MD, cardiology fellow, and Jason H. Wasfy, MD, MPhil, medical director of the Massachusetts General Physicians Organization and director of Quality and Analytics at the Cardiology Division at Massachusetts General Hospital, and colleagues have found that recent outcomes of women with T2MI have been comparable to those of men. This is the first study to evaluate sex differences in T2MI care and outcomes. Their findings appear in a letter to the editor of the Journal of the American College of Cardiology.
A Retrospective Cohort
The researchers identified 359 patients who were diagnosed with T2MI at Mass General between October 2017 and May 2018. Of those, 204 (57%) were men. They found no differences between men and women in the causes of T2MI (mainly heart failure, respiratory failure, sepsis, arrhythmias or hypertensive urgency).
Women were significantly less likely than men to have coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting and peripheral artery disease.
Testing and Revascularization
- There were no sex-based differences in the frequency of echocardiography or new regional wall motion abnormalities. However, men had a significantly lower average ejection fraction than women (50% vs. 57%; P < .001)
- There was no disparity between the sexes in the proportions of patients who received stress tests or the proportions who had positive results on stress tests
- The proportions of patients who underwent coronary angiography were similar between men and women, but substantially more men than women had obstructive coronary artery disease (67% vs. 14%; P = .003)
- Men and women were comparable with respect to the number of inpatient percutaneous coronary interventions and inpatient coronary artery bypass grafting procedures performed
- At discharge, men were significantly more likely than women to be prescribed aspirin (76% vs. 61%; P = .003) and clopidogrel (14% vs. 6%; P = .01), but there were no differences in new prescriptions of these agents
- Prescriptions of beta-blockers, statins, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers were similar among men and women at discharge
In multivariable logistic regression analysis, there were no significant differences between men and women in 90-day mortality (18% vs. 19%) or post-discharge 90-day readmission rates (39% vs. 34%).
Although men and women were comparable in most ways, the fact that women had a lower prevalence of obstructive coronary artery disease makes it plausible that their ischemia is predominantly microvascular. This is of concern because impaired microvascular function predicts adverse cardiovascular outcomes in women with signs and symptoms of ischemia.
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