Abstract
Background: Previous studies have reported sex-specific differences in the presentation, mechanisms, and outcomes of acute myocardial infarction (AMI). Objective: To assess differences in the incidence and in-hospital outcomes of left ventricular (LV) aneurysm complicating AMI in women and men. Methods: We used the National Inpatient Sample database (NIS) from 2000 to 2017, to identify adult hospitalizations with a primary diagnosis of AMI and concomitant LV aneurysm. Incidence and trends in in-hospital mortality, complications, length of stay and costs were analyzed in women and men. Results: A total of 16,334 AMI hospitalizations with LV aneurysm were identified including 6,994 (42.8%) women and 9,340 (57.2%) men. Women had a higher incidence of LV aneurysm compared to men (0.16% vs. 0.14%; p<0.001). Compared to men, women were older (73 [63-81] vs 65 [56-75]; p<0.001), black race (9.6% vs 7.4%; p=0.1), and have higher elixhauser comorbidity index (2 [-1 to 9] vs 0 [-1 to 8]; p=0.014). Unadjusted in-hospital mortality was higher in women than men (12.7% vs. 7.2%; p<0.001). After adjusting for demographic and baseline characteristics and excluding inter-hospital transfers, women with AMI complicated by LV aneurysm had 49% greater odds of in-hospital mortality than men (aOR 1.49, 95% Confidence Interval 1.06-2.10, p=0.02). Women with LV aneurysm were less likely than men to undergo percutaneous coronary intervention (28.5% vs. 35.4%; p<0.001), bypass surgery (15.8% vs. 25.1%; p<0.001), coronary atherectomy (0.8% vs. 1.9%; p=0.009) and LV aneurysm surgery (7.8% vs. 11.1%; p=0.001). Conclusions: In this large population-based cohort study, women had a slightly higher incidence but dramatically higher in-hospital mortality associated with LV aneurysm complicating AMI compared to men. Further research is necessary to validate strategies to ensure that women receive guideline-directed therapy for AMI and LV aneurysm to address the sex disparity in mortality.
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