Gender perspective on risk factors, coronary lesions and long-term outcome in young patients with ST-elevation myocardial infarction

Objective Previous data on young patients with acute coronary syndrome (ACS) have indicated higher rates of normal coronary angiograms but higher mortality in women than men. However, ST-elevation myocardial infarction (STEMI) differs from non-ST-elevation ACS in many aspects. We elucidated sex differences in risk factors, angiographic findings and outcome in consecutive STEMI patients below 46 years of age. Design Retrospective cohort study. Setting The Swedish registers for CCU care and coronary angioplasty; RIKS-HIA and SCAAR. Patients 2132 STEMI patients below 46 years of age admitted to intensive coronary care units in Sweden between 1995 and 2006 and followed for at least 1 year. Main outcome measures Angiographic findings and short-term and long-term mortality. Results Risk factors were more common in women. Significant coronary lesions were equally common (92.1% vs 93.1%, p=0.64) while single vessel disease was more common (72.9% vs 59.3%; p<0.001) in women. Women had higher multivariable adjusted in-hospital mortality, OR 2.85 (95% CI 1.31 to 6.19) while long-term mortality was the same, HR 0.93 (95% CI 0.60 to 1.45). The catch-up of mortality in men might be related to a higher occurrence of re-infarctions, HR 1.82 (95% CI 1.25 to 2.65). Conclusions STEMI below age 46 is a more rare condition in women than in men and more often related to cardiovascular risk factors. More than 90% of both men and women had coronary lesions, in women more often single vessel lesions. Female sex is associated with higher in-hospital mortality, while long-term mortality is low without difference between genders.