Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data

Ana Lopez-De-Andres,Valentin Hernández-Barrera,Rodrigo Jimenez-Garcia,Javier De Miguel-Diez,Romana Albaladejo-Vicente,Marta Lopez-Herranz,David Carabantes-Alarcon,Rosa Villanueva-Orbaiz,Jose M De Miguel-Yanes,Jose J Zamorano-Leon

doi:10.1186/s12933-021-01273-y

Abstract

BackgroundTo analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences.MethodsUsing the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM.ResultsMI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28–2.36) and NSTEMI (IRR 2.91; 95% CI 2.88–2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI.ConclusionsT2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.

Highlights

To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the pres‐ ence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences
Study design and data source We conducted a retrospective observational study based on the Spanish National Hospital Discharge Database (SNHDD), which is managed by the Spanish Ministry of Health and includes over 95% of all hospital discharges in Spain resulting in data from more than 4.2 million discharges each year
Incidence of STEMI and NSTEMI according to type 2 diabetes mellitus (T2DM) The total incidence of MI was higher (p < 0.001) among the T2DM population (536.91 per 100,000 persons with T2DM) than among those without T2DM (159.76 per 100,000 persons without T2DM) resulting in an adjusted incidence rate ratios (IRR) of 2.47

Summary

Introduction

Use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the pres‐ ence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences. Several studies have found a greater risk of death after MI in patients with diabetes than in those without diabetes [7, 8] in subtypes of coronary syndromes including unstable angina, ST-elevation MI (STEMI), and nonST-elevation MI (NSTEMI) [9, 10]. Sex differences may play an active role in the incidence and outcomes of CVD, including MI [11]. Berger et al [12] observed sex-based differences in their STEMI cohort, with 30-day mortality being higher among women (adjusted OR, 1.15; 95% CI 1.06–1.24), whereas mortality was lower among women in the NSTEMI cohort (adjusted OR, 0.77; 95% CI 0.63–0.95) and unstable angina cohort (adjusted OR, 0.55; 95% CI 0.43–0.70)

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