Sex Differences in Outcomes of Young Adults Hospitalized With First Myocardial Infarction From 2011 to 2022.
Academic Article
Overview
abstract
BACKGROUND: Acute myocardial infarction (AMI) hospitalizations are increasing in young adults, but outcomes stratified by sex and AMI subtype are not well understood. METHODS: First AMI hospitalizations among young adults 18 to 54 years old were analyzed from 2011 to 2022 in the United States from the National Inpatient Sample and stratified by subtype (ST-segment-elevation myocardial infarction [STEMI] and non-ST-segment-elevation myocardial infarction) and sex. In-hospital mortality by first AMI-subtype was the primary outcome, including in-hospital mortality trends using orthogonal polynomial contrasts; in-hospital complications were secondary outcomes. Patient characteristics included traditional and nontraditional risk factors. All analyses were performed sex-stratified with adjustment using a sequential additive multivariable logistic regression model. RESULTS: Among 945 977 weighted first AMI hospitalizations in young adults, 356 115 (37.6%) were STEMI and 589 862 (62.4%) were non-ST-segment-elevation myocardial infarction. Overall, adjusted in-hospital mortality increased significantly for first STEMI (1.2% absolute increase, Ptrend<0.001) and was unchanged for first non-ST-segment-elevation myocardial infarction (0.2% absolute decrease, Ptrend=0.70) across the study period. Compared with young men, young women had higher in-hospital mortality compared with young men (STEMI: 3.1% versus 2.6%, P<0.001; non-ST-segment-elevation myocardial infarction: 1.0% versus 0.8%, P=0.03) and experienced similar in-hospital complications with lower receipt of cardiovascular procedures. Irrespective of sex, more nontraditional than traditional risk factors were independently associated with higher odds of in-hospital mortality. CONCLUSIONS: There was a rise in first STEMI in-hospital mortality among young adults from 2011 to 2022. Mortality for both AMI subtypes was higher in young women and was associated with more nontraditional compared with traditional risk factors.
