Comparison of clinical symptoms and prognosis of non-post-menopausal women to age matched men admitted with ST-elevation myocardial infarctions

Abstract Background Although ST-elevation-myocardial infarctions (STEMI) in women before menopause are relatively uncommon, previous studies have shown that women in general are more likely to present with atypical symptoms and to show higher adverse event rates, which might at least be attributable to the on average higher age of women during the index event. Aim of the present study was therefore to compare in an age-matched cohort of STEMI-patients younger 55 years the likelihood of atypical symptoms between genders and to investigate the impact of female gender on short and long-term-outcome. Methods Patients <55 years of age with STEMI admitted between 2006 and 2022 to a German heart center were included in the analysis and women were compared to men with regard to clinical symptoms and outcome. To exclude local bias women of all ages with STEMI from the registry were compared to men in a control group. Results Of 12094 STEMI-patients in the total cohort 3343 (28%) were women and 8751 (72%) were men. Women had a mean age of 69.7±13 yrs. compared to 62.2±12 in men. Women with STEMI had a 40% higher chance to present without typical chest pain (no CP, 12.0% vs. 8.5%, p<0.01) and were more likely to present with dyspnea (26.1% vs. 22.7% p<0.01). While rates of late STEMI-presenters were numerically higher in women, this difference failed to reach significance (12.8% vs. 11.9%, p=0.16). When focusing however on the study group (<55 yrs. of age) there was no more age difference (women 47.2±6 yrs. vs. 47.5±6 yrs. in men, p<0.3) and rates of no CP were not different between genders: 5.7%(women) vs. 5.4% (men), p=0.79, nor were rates of dyspnea : 20.0% (women) vs. 18.5% (men), p=0.45. There was even a trend towards lower rates of late STEMI-presenters in women: 8.3% vs. 10.9% in men, p=0.077, although diabetes-rates were higher in women (16.9% vs. 11.8%, p<0.01). Despite similar initial symptom presentations, women showed a marked 60% increase in 30-day- (6.9% vs. 4.3%, p=0.017) and 1-year-mortality (8.7% vs. 5.3%, p<0.01). The disadvantage for women remained, when adjusting mortality rates for confounders (age, diabetes, anterior STEMI, multivessel disease, PCI result) in a Cox regression model (table, upper part). This could be confirmed in a subgroup multivariate analysis excluding patients with no CP or not undergoing emergency PCI (table, lower part). Conclusions In STEMI-patients younger 55 years women showed a more than 60% higher short- and long-term-mortality compared to their male peers. This disadvantage, at least with our data, cannot be sufficiently explained by higher rates of delayed STEMI-presentations or absence of typical chest pain. Further studies are needed to identify possible causes for this higher vulnerability of young women to acute myocardial infarctions.Table:Mortality in Women vs. men<55 yrs