Greater CV, all-cause readmissions after acute MI for younger women vs. men
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Younger women are much more likely than younger men to be readmitted to the hospital after an acute MI for CV or any cause, with data reflecting a higher prevalence of CV risk factors and comorbidities among women compared with men.
In a large observational study using population-linked data in Ontario, Canada, researchers also found that coronary angiography is performed almost universally in younger women with acute MI; however, coronary revascularization is less frequent in women than in men, perhaps reflecting less obstructive disease.
“The increased rate of all-cause readmission is an interesting finding given our angiographic data demonstrating higher rates of normal coronary arteries or nonobstructive disease among women,” Mina Madan, MD, MHS, FRCPC, FSCAI, an academic interventional cardiologist and director of interventional cardiology clinical trials research at Sunnybrook Health Sciences Centre in Toronto, and colleagues wrote in the Canadian Journal of Cardiology. “We expected that less angiographic disease may lead to fewer readmissions and less use of health care services in women, but this was not the case.”
Study data
Madan and colleagues analyzed data from 38,071 adults aged 55 years and younger hospitalized with acute MI between April 2009 and March 2019 in Ontario. Within the cohort, 21.2% were women; the mean age at acute MI presentation was 49 years. Researchers compared trends in comorbidities, angiographic findings and revascularization rates in men and women. The primary outcome was 1-year all-cause mortality or readmission for unstable angina, acute MI, HF or stroke.
During follow-up, the rate of diabetes among women rose from 24.8% to 34.9% (P for trend < .001). whereas the rate of smoking among women fell from 53.2% to 41.7% (P for trend < .005).
Although most patients received coronary angiography (96%), coronary revascularization was less frequent among women vs. men; the rate of PCI was 61.9% vs. 78.8%, respectively (P < .001), and the rate of surgery was 4.1% vs. 6%, respectively (P < .001).
Women were more likely than men to have normal coronary anatomy (5.8% vs. 1.7%; P < .001) and nonobstructive disease (22.8% vs. 9.3%; P < .001).
Compared with men, the primary composite endpoint was more frequent in women at 10% vs. 7.9%, respectively, for an adjusted HR of 1.11 (95% CI, 1.02-1.21; P = .02) and related to increased readmission rates for CV events. Incidence of 1-year all-cause readmission was similarly greater among women vs. men at 25.8% vs. 21.1%, respectively, for an adjusted HR of 1.34 (95% CI, 1.27-1.42; P < .0001).
“By 2018, the use of coronary angiography was largely universal for both sexes and high levels of primary and specialist care were taking place after hospitalization,” the researchers wrote. “The lower rate of PCI among younger women may reflect increasing recognition of alternative pathophysiology for acute MI among women in this age group. Our study also underscores the need for ongoing intensive primary prevention strategies directed at younger women.”
‘Urgent need’ to understand disparities
In a related editorial, Karin H. Humphries, DSc, MBA, FAHA, the UBC-Heart and Stroke Foundation Professor in Women’s Cardiovascular Health and director of the Cardiovascular Health Program at the University of British Columbia, and colleagues wrote that the findings demonstrate sex differences in acute MI are “diminishing,” the high rates of CV risk factors among younger women requires attention.
“Particularly concerning is the increase in diabetes: 0.99% per year in women compared with 0.45% per year in men,” Humphries and colleagues wrote. “There is also an urgent need to understand what is driving the higher readmission rates in females. Is this caused by unrecognized depression, less use of evidence-based medication post-acute MI or delays in access to care? Gender roles were not addressed in this study, but their importance needs to be considered, given the impact of gender on the likelihood of follow-up, economic challenges with filling prescriptions and stress associated with work and family responsibilities, particularly in this young age group. More focus on these areas of investigation is clearly needed.”
Reference:
Humphries KH, et al. Can J Cardiol. 2022;doi:10.1016/j,cjca.2022.08.227.
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