Sex differences in investigations and outcomes among patients with type 2 myocardial infarction

Kimenai, Dorien M; Lindahl, Bertil; Chapman, Andrew R.; Baron, Tomasz; Gard, Anton; Wereski, Ryan; Meex, Steven J.R.; Jernberg, Tomas; Eggers, Kai M.

doi:10.1136/heartjnl-2021-319118

Cited by 12 publications

(14 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…types, so less is known about sex differences with respect to MI type. Recent studies examining sex differences in the general population highlighted that men tend to be more likely to experience T1MI than women but that men and women experience T2MI at similar rates [52,53]. This is consistent with our T1MI findings, reinforcing the idea that T1MI is also likely to be higher among men in people living with HIV.…”

Section: Discussionsupporting

confidence: 91%

Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV

et al. 2023

View full text Add to dashboard Cite

Objectives People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand–supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. Design and Methods Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time‐updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. Results Among 13 506 people living with HIV, with a median 4 years of follow‐up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. Conclusions Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.

show abstract

Section: Discussionsupporting

confidence: 91%

Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Sex-disparities in the management of type 2 MI may exist but evidence is still limited 14 , 15 . In a previous investigation from the SWEDEHEART registry, no indication of sex bias in the selection of type 2 MI patients for cardiac investigations was found 16 . We here extend these findings by demonstrating that temporal trends in medical interventions did not differ between women and men.…”

Section: Discussionmentioning

confidence: 82%

Management and outcome trends in type 2 myocardial infarction: an investigation from the SWEDEHEART registry

Eggers

Baron

Chapman

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Despite poor prognosis, patients with type 2 myocardial infarction (MI) tend to be underdiagnosed and undertreated compared to those with type 1 MI. Whether this discrepancy has improved over time is uncertain. We conducted a registry-based cohort study investigating type 2 MI patients managed at Swedish coronary care units (n = 14,833) during 2010–2022. Multivariable-adjusted changes (first three vs last three calendar years of the observation period) were assessed regarding diagnostic examinations (echocardiography, coronary assessment), provision of cardioprotective medications (betablockers, renin–angiotensin–aldosterone-system inhibitors, statins) and 1-year all-cause mortality. Compared to type 1 MI patients (n = 184,329), those with type 2 MI less often had diagnostic examinations and cardioprotective medications. Increases in the use of echocardiography (OR 1.08 [95% confidence interval 1.06–1.09]) and coronary assessment (OR 1.06 [95% confidence interval 1.04–1.08]) were smaller compared to type 1 MI (pinteraction < 0.001). The provision of medications did not increase in type 2 MI. All-cause mortality rate in type 2 MI was 25.4% without temporal change (OR 1.03 [95% confidence interval 0.98–1.07]). Taken together, the provision of medications and all-cause mortality did ot improve in type 2 MI despite modest increases in diagnostic procedures. This emphasizes the need of defining optimal care pathways in these patients.

show abstract

“…In all, 21 studies were included for final review and analysis. 5,7,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] There were 408,586 patients: 341,049 in the T1MI group and 67,537 in the T2MI group. The mean age was similar between both groups (T1MI: 67.3 years vs T2MI: 71.03 years), with a gender distribution of females of 37.81% and 47.15% for T1MI and T2MI, respectively.…”

Section: Resultsmentioning

confidence: 99%

Comparison of outcome among type 2 vs type 1 myocardial infarction: a systematic review and meta-analysis

Jaiswal

Ang

Ishak

et al. 2023

Journal of Investigative Medicine

View full text Add to dashboard Cite

To date, there were limited studies available on myocardial infarction (MI), and consequently, the outcomes of patients with type 1 myocardial infarction (T1MI) compared to type 2 myocardial infarction (T2MI) remained inconclusive. We aimed to compare the outcomes of T1MI and T2MI patients in terms of mortality and adverse cardiovascular outcomes. We performed a systematic literature search on PubMed, Embase, and Scopus for relevant articles from inception until March 20, 2022. 341,049 patients had T1MI, while the remaining 67,537 patients had T2MI. Mean age was similar between both groups (T1MI: 67.3 years, T2MI: 71.03 years), while the proportion of females was lower in T1MI (37.81% vs 47.15%). Our analysis revealed that patients with T1MI had significantly lower odds of all-cause mortality (OR 0.45, 95% CI 0.36–0.56, p < 0.001), in-hospital mortality (OR 0.63, 95% CI 0.46–0.86, p < 0.001), 1-year mortality (OR 0.35, 95% CI 0.25–0.47, p < 0.001), and major adverse cardiovascular events (MACE) (OR 0.59, 95% CI 0.39–0.91, p = 0.02). There was no significant difference in terms of 30-day mortality (OR 0.58, 95% CI 0.25–1.36, p = 0.21), cardiovascular mortality (OR 0.95, 95% CI 0.68–1.32, p = 0.74), all-cause readmission (OR 0.84, 95% CI 0.62–1.14, p = 0.26), and readmission due to MI (OR 1.22, 95% CI 0.66–2.27, p = 0.53) between both groups. Patients with T1MI had favorable outcomes in terms of mortality and MACE compared to that of T2MI patients. Further studies should aim at determining the optimal management strategy for these high-risk patients for better patient outcomes.

show abstract

Sex differences in investigations and outcomes among patients with type 2 myocardial infarction

Cited by 12 publications

References 31 publications

Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV

Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV

Management and outcome trends in type 2 myocardial infarction: an investigation from the SWEDEHEART registry

Comparison of outcome among type 2 vs type 1 myocardial infarction: a systematic review and meta-analysis

Contact Info

Product

Resources

About