Androgen-Modulating Drugs and Severe Complications After ST-Elevation Myocardial Infarction

Importance: Male sex and endogenous testosterone have been shown to exacerbate neutrophilia and cardiac injury in myocardial infarction (MI), raising questions about protective actions of androgen-modulating drugs in acute ST-elevation MI (STEMI). Objective: To determine whether the use of 5-alpha reductase inhibitors (5αRIs) or androgen deprivation therapy (ADT), drugs that lower androgen actions, is associated with a reduced frequency of severe complications after percutaneous coronary intervention (PCI)-treated STEMI in men. Design, Setting, and Participants: Nationwide, registry-based cohort study of men aged 35 to 84 years with first-time STEMI treated with PCI from January 2006 to December 2022 in Sweden. Propensity score matching was used to match men treated with 5αRIs or ADT with untreated control patients. The primary outcome was a composite of mortality within 30 days and severe in-hospital complications. Data were analyzed in June 2026. Main Outcomes and Measures: The primary outcome was a composite of mortality within 30 days and severe in-hospital complications (any of: cardiac arrest and resucitatation, atrioventricular block stage II or III, cardiogenic schock, new-onset atrial fibrillation or flutter, severely depressed left ventricular function, or mechanical complication). Odds ratios were calculated using conditional logistic regression. Results: In this study of men with PCI-treated STEMI, 1305 men treated with 5αRI (mean [SD] age, 74.2 [6.7] years) were matched to 6463 control patients, and 358 men treated with ADT (mean [SD] age, 76.2 [6.2] years) were matched to 1774 control patients. The odds of experiencing a severe complication were lower in men treated with 5αRIs (odds ratio [OR], 0.80; 95% CI, 0.69-0.93). No significant association was observed for men treated with ADT compared with their matched control patients (OR, 1.10; 95% CI, 0.83-1.45). Conclusions and Relevance: In this cohort study of men with PCI-treated STEMI, use of 5αRI but not ADT was associated with a lower risk of severe complications. These results warrant further research into the role of androgens and drugs that affect androgen levels in the acute phase of STEMI.