Gender differences in survival and its predictors in patients after myocardial infarction: data analysis from the RIMIS register

Aim. Among patients who survived acute myocardial infarction (MI) with ST segment elevation (STEMI), to assess gender differences in clinical and anamnestic indicators, long-term survival, as well as factors affecting it. To compare the effect of recurrent MI on long-term survival in men and women.
Material and methods. Data from the retro-prospective RIMIS register were used. In 2017, 214 patients with STEMI were admitted to the emergency cardiology department of the vascular center, 23 (10.8%) of them died in the hospital. After 6 years, the life status of patients discharged from the hospital was assessed (191 people, 129 men, 62 women). The response was 93.2%. The factors influencing the fatal outcome were assessed using a model of proportional Coke risks separately for men and women. The primary endpoint was the overall patient’s mortality.
Results. The women who survived MI were, on average, 16.5 years older than the men who survived, and they were more likely to have concomitant diseases (diabetes mellitus, obesity). During the follow-up period, 34 men (26.4%) and 26 women (41.9%) died. Kaplan-Meyer curves demonstrated significantly worse survival in women compared to men. However, after the age adjustment was introduced, the risk of death in women was lower than in men (HR =0.981 (0.968-0.993), p=0.003). The main mortality predictors in women were hospitalization before reference MI, a history of coronary heart disease, a history of cerebral stroke, and anemia. In men, the main predictor of death was the presence of disability, the fact of recurrent MI, a history of chronic kidney disease and the presence of oncology (the latter two factors were rare, respectively, in 6.2% and 3.9% of patients).
Conclusion. Women suffered MI much later than men. Therefore, higher mortality rates after MI were mainly determined by concomitant diseases. The main mortality predictor in men was recurrent MI. The age-adjusted risk of death after MI is lower in women than in men.

1. Samorodskaya IV, Klyuchnikov IV, Shepel RN, et al. Regional variability of male and female mortality from three types of coronary artery disease: comparison of two periods 2017-2019 and 2020-2022. Cardiovascular Therapy and Prevention. 2024;23(4):3984. (In Russ.) DOI: 10.15829/1728-8800-2024-3984.

2. Lilothia SH. Gender inequality and cardiovascular diseases. Russian Journal of Cardiology. 2024;29(6):5873 (In Russ.) DOI: 10.15829/1560-4071-2024-5873.

3. Lee CY, Liu KT, Lu HT, et al. Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease DatabaseAcute Coronary Syndrome (NCVD-ACS) registry. PLoS One. 2021;16(2):e0246474. DOI: 10.1371/journal.pone.0246474.

4. Hellgren T, Blöndal M, Jortveit J, et al. Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries. Eur Heart J Open. 2022;2(4):oeac042. DOI: 10.1093/ehjopen/oeac042.

5. Kosmidou I, Leon MB, Zhang Y, et al. Long-Term Outcomes in Women and Men Following Percutaneous Coronary Intervention. J Am Coll Cardiol. 2020;75(14):1631-40. DOI: 10.1016/j.jacc.2020.01.056.

6. Gottlieb S, Harpaz D, Shotan A, et al. Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community-based study. Israeli Thrombolytic Survey Group. Circulation. 2000;102(20):2484-90. DOI: 10.1161/01.cir.102.20.2484.

7. Erlikh AD, Shevchenko II, Alekseev DV, et al. Acute coronary syndrome in clinical practice: gender specifics of risk levels, treatment, and outcomes: RECORD Registry results. Cardiovascular Therapy and Prevention. 2011;10(8):45-51 (In Russ.).

8. Martsevich SYu, Afonina OS, Zagrebelnyy AV, et al. Comparative assessment of long-term survival of patients after primary and recurrent myocardial infarction: a data from the RIMIS registry. Cardiovascular Therapy and Prevention. 2024;23(5):4001. (In Russ.). DOI: 10.15829/1728-8800-2024-4001.

9. Martsevich SYu, Zagrebelnyy AV, Afonina OS, et al. Study of the course of recurrent myocardial infarction in the acute stage within the framework the hospital register. Rational Pharmacotherapy in Cardiology. 2024;20(1):46-51. (In Russ.). DOI: 10.20996/1819-6446-2024-3008.

10. Martsevich SYu, Lukina YuV, Kutishenko NP, et al. Medical registers. Role in evidence-based medicine. Guidelines for creation. Methodological guidelines. M.: ROPNIZ, Silicea-Poligraf, 2023. (In Russ.). DOI: 10.15829/ROPNIZ-m1-2023.

11. Russian Society of Cardiology. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ.) DOI: 10.15829/29/1560-4071-2020-4103.

12. Kunadian V, Qiu W, Lagerqvist B, et al. Gender Differences in Outcomes and Predictors of All-Cause Mortality After Percutaneous Coronary Intervention (Data from United Kingdom and Sweden). Am J Cardiol. 2017;119(2):210-6. DOI: 10.1016/j.amjcard.2016.09.052.