In-Hospital Mortality Elevated Among Female Patients Who Had AMI and MC

Higher in-hospital mortality rates were seen among female patients vs male patients admitted to the hospital for an acute myocardial infarction (AMI) who then developed mechanical complications (MC), according to a poster¹ presented at the recent American Society for Preventive Cardiology’s Congress on CVD Prevention, which was held in Arlington, Texas, July 21-23.

“Mechanical complications are rare, yet very serious complications of acute myocardial infarction,” the study authors wrote. “Data on the sex differences in characteristics and outcomes of AMI with MC are limited.”

Data from January 1, 2012, through December 31, 2020, came from the National In-Patient Sample on women 18 years and older with dual AMI and MC diagnoses. The primary outcome was sex differences for in-hospital mortality, and their secondary outcomes were differences in acute kidney injury (AKI), major bleeding, use of inotropes—medications that help the heart muscles adjust to contract harder or easier²—permanent pacemaker implantation (PPI), performance of percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), surgery (ventricular septal defect repair and mitral valve surgery), pericardiocentesis, mechanical circulatory support, ischemic stroke, and mechanical ventilation.

The female patients in this analysis had an older mean (SD) age of 72.0 (0.53) years vs 65.0 (0.40) for the male patients (P < .000), and there were 2 overall cohorts: 1,464,770 patients who had an ST-segment elevation MI (STEMI) and 3,739,574 who had non-STEMI (NSTEMI). Of these, 2915 in the STEMI group had MC and 629 in the NSTEMI group did not have MC. Sixty-two percent of the overall study population were male patients.

Overall, for in-hospital mortality, having MC vs not having MC led to a 39% higher rate among the female patients with AMI compared with male patients (adjusted odds ratio [aOR], 1.39; 95% CI, 1.079-1.798; P < .01), a 50% higher rate in the female patients who had a STEMI, and a 21% higher rate in those who had an NSTEMI. Further, among the female patients who had a STEMI without MC, the rate of in-hospital mortality was also elevated, by 13%. The most significant difference was seen between those who had an NSTEMI with or without complications: 21% higher rate vs a 10% reduced rate, respectively.

For the secondary outcomes investigated, the female patients who had an AMI with no MC had greater reduced rates of the following compared with those who had MC, respectively:

• Vasopressor use: 22% drop vs 45% rise
• AKI: 26% vs 25% drop
• PCI: 26% vs 11% drop
• CABG: 53% vs 51% drop
• Circulatory support: 37% vs 20% drop
• Mechanical ventilation: 20% vs 16% drop

Among those who had a STEMI, not having MC vs having MC, respectively, correlated with greater reduced rates of in-hospital AKI (34% vs 7%), PCI (20% vs 14%), CABG (54% vs 50%), and mechanical ventilation (15% vs 11%). And for those who had an NSTEMI without MC, 28%, 8%, 23%, 22%, 55%, 20%, 20%, and 19% reduced risks were seen for vasopressor use, PPM, AKI, PCI, CABG, surgery, circulatory support, and mechanical ventilation, respectively.

Men were more likely overall to have AKI (P < .05) and to undergo CABG (P < .00), and women were more likely to have a stroke (P < .05) no matter their type of MI. The authors also determined that age older than 50 years and female sex, but only for those who had an AMI with MC, were independent predictors of in-hospital mortality (P < .00).

Reference

1. Rivera FB, Salva WF, Gonzales JS, et al. Sex differences in trends and outcomes of acute myocardial infarction with mechanical complications in the United States. Presented at: ASPC Congress on CVD Prevention; July 21-23, 2023; Arlington, Texas. Poster 181.

2. Inotropes. Cleveland Clinic. Updated May 17, 2022. Accessed July 27, 2023. https://my.clevelandclinic.org/health/treatments/23032-inotropes