Women Who Experience Myocardial Infarction at a Young Age Have Worse Outcomes Compared With Men: Results From the YOUNG MI Registry

Abstract

Background: Prior studies have highlighted known sex differences among patients experiencing a myocardial infarction (MI), but there is a scarcity of data regarding young patients presenting with a first MI, particularly regarding long-term outcomes. Our aim was to investigate differences in risk factors, clinical presentation, management, and all-cause mortality among men and women who experience their first MI at a young age. Methods: We retrospectively included all consecutive patients with age ≤ 50 years, presenting to two large medical centers with a Type 1 MI from 2000 through 2016. The presence and type of MI was adjudicated based on the Third Universal Definition on MI. Vital status was identified by the Social Security Administration’s Death Masterfile. Cause of death was adjudicated using electronic health records and death certificates. Results: 2097 individuals had an MI (mean age 44±5.1 years, 73% white, 53% STEMI) with median follow-up of 11.2 years (interquartile range: 7.3-14.2). Women presented with greater risk factor burden and had a longer median length of stay (4.0 vs. 3.0 days, p=0.012). Women were less likely than men to undergo invasive coronary angiography (93.5% vs. 96.7%, p=0.003) and coronary revascularization procedures (82.1% vs. 92.6%, p<0.001), and were less likely to be discharged with appropriate post-MI medications. While there was no significant difference in hospital mortality between men and women, among those who survived to hospital discharge, women had a higher long-term mortality (adjusted HR=1.51, p=0.009). Conclusions: Women who experienced their first MI under the age of 50 had a higher burden of traditional risk factors compared to men, and were less likely to be undergo coronary revascularization and treated with guideline-directed post MI medical therapies. Furthermore, women who survived hospitalization experienced significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these disparities may lead to improved care for young women with cardiovascular disease.