WOMEN with acute myocardial infarction (AMI) who develop ventricular arrhythmias are less likely to receive procedural care despite higher risks of adverse outcomes. Previous research has established disparities in the incidence, presentation, and outcomes of AMI between men and women. Following this, researchers investigated sex-specific differences in in-hospital, adverse outcomes of patients with AMI who develop ventricular arrhythmias.
The research team carried out a retrospective analysis of 174,565 patients admitted between 2016 and 2020 with type 1 AMI who underwent revascularization (percutaneous coronary intervention or coronary artery bypass grafting) and had a secondary diagnosis of ventricular arrhythmias. Analysis with multivariable logistic regression revealed that the risk of developing ventricular arrhythmias post-AMI was higher in men than women (12.6 versus 8.8% adjusted odds ratio [AOR]: 1.72; p<0.001). However, women were significantly more at risk of in-hospital mortality (AOR: 1.32; p<0.001), cardiogenic shock (AOR: 1.08; p<0.022), and cardiac arrest (AOR: 1.11; p<0.002). The elevated risks remained after accounting for age, rates of congestive heart failure, diabetes mellitus and Charlson comorbidity index scores.
Despite worse in-hospital outcomes, women were less likely to receive an implantable cardioverter defibrillator (ICD) (AOR: 0.57; CI: 0.47-0.68; P < 0.001) or undergo catheter ablation (AOR: 0.51; CI: 0.27-0.98; P < 0.001) during hospital admission, as compared to men. Whilst some studies have suggested higher complications of ICD implantation in women or a greater benefit in men, these claims have not been substantiated with sufficient data and therefore do not warrant the sex disparities in ICD implantation.
The findings of this study highlight an important disparity in both in-hospital outcomes and treatment procedures between men and women with post-AMI ventricular arrhythmias, with women less likely to receive appropriate procedural care despite worse outcomes. Future research should elucidate underlying sex-based differences in cardiovascular disease, with the aim of developing targeted interventions to address sex-specific risk factors associated with outcomes following AMI and improve outcomes among women.
Katrina Thornber, EMJ
Reference
Markson FE et al. Sex differences in ventricular arrhythmias and adverse outcomes following acute myocardial infarction. JACC: Advances. 2024;DOI: 10.1016/j.jacadv.2024.101042.
