Sex-based differences in presentation, treatment, and complications among middle-aged and older adults hospitalized for acute myocardial infarction: a cross-sectional study

Abstract Background Sex-related differences in acute myocardial infarction (AMI) may involve clinical presentation, infarction phenotype, treatment, and short-term outcomes, with potential variation across age groups. This study evaluated sex-based differences among middle-aged and older patients hospitalized with AMI. Methods This observational study included 1,312 patients hospitalized with AMI between 4 May 2021 and 3 January 2024. Demographic characteristics, presenting symptoms, AMI subtype, Killip class, clinical variables, treatment, revascularization, and in-hospital outcomes were compared between women and men. Analyses were additionally stratified by age group. Categorical variables were analyzed using chi-square or Fisher’s exact tests, and continuous variables using independent-samples t -tests or Mann–Whitney U tests, as appropriate. Effect estimates with 95% confidence intervals (CIs) were reported. Results Of 1,312 patients, 409 (31.2%) were women and 903 (68.8%) were men. Women more frequently presented with respiratory symptoms, other discomfort, gastrointestinal symptoms, and weakness/fatigue, whereas primary chest pain was more frequent among men. NSTEMI was more frequent among women than men (86.8% vs. 56.0%; OR 5.16, 95% CI 3.76–7.07; P < 0.001), while STEMI was more frequent among men. Higher Killip classes were more frequently observed among women ( P < 0.001). Women also demonstrated higher GRACE scores and lower eGFR. Treatment patterns differed between sexes, and primary PCI among STEMI patients was more frequently documented among men. In-hospital mortality did not differ significantly between women and men (6.1% vs. 5.3%; OR 1.16, 95% CI 0.70–1.91; P = 0.560). Age-stratified analyses demonstrated heterogeneous sex differences. Conclusion Sex-based differences in AMI were evident across presentation, infarction subtype, clinical risk profile, and treatment patterns, but were not associated with a significant difference in in-hospital mortality.