Bridging the Sex Gap in Early Myocardial Infarction Mortality: Why It Matters.

Abstract

Cardiovascular disease (CVD) mortality in women surpassed that of men in 19841 triggering an intense focus to increase awareness, explore sex-specific influences, and enhance evidence-based treatment of CVD in women. These efforts have yielded benefit with declines in CVD mortality in women and subsequent elimination of the sex gap.1 Despite these successes, overall declines in CVD mortality have leveled, and in 2012, heart disease deaths increased slightly.2 Of particular concern are women aged 45 to 65 years who have increased rates of myocardial infarction (MI) associated with a higher in-hospital mortality than their male counterparts.3 See Article by Smilowitz et al Sex differences are evident in pathophysiology, treatment, and outcomes of MI. Women are more likely to die in the first year after an MI, experience non–ST-segment–elevation MI, MI with nonobstructive coronary artery disease (MINOCA) and plaque erosion, and have lower rates of plaque rupture (76% versus 55%) compared with men.4,5 Women are less frequently referred for appropriate treatment, have lower utilization rates for efficacious therapies, and experience higher rates of post-MI complications as compared with men.4 These sex differences in pathogenesis and management of MI remain prescient topics for a 21st-century cardiovascular research agenda. In this issue of Circulation: Cardiovascular Quality and Outcomes , Smilowitz et al6 report an analysis of age, sex, and outcome differences in MINOCA and MI with obstructive coronary artery disease (MI-CAD) in a contemporary data set—the NCDR (National Cardiovascular Data Registry) ACTION Registry-GWTG (Acute Coronary Treatment Intervention Outcomes Network Registry–Get With the Guidelines). Consistent with previous reports, the authors found that MINOCA was rare among patients with MI and was associated with lower mortality in comparison with MI-CAD. However, the discovery that higher post-MI mortality in women as compared with men was driven by the …