Department of Internal Medicine Rutgers Health/Community Medical Center Toms River NJ.
Department of Internal Medicine Texas Tech University Health Science Center El Paso TX.
J Am Heart Assoc. 2024 Aug 6;13(15):e035329. doi: 10.1161/JAHA.124.035329. Epub 2024 Jul 31.
Although myocardial infarction with nonobstructive coronary arteries (MINOCA) is more common in women, it is unknown whether sex is a risk factor for adverse outcomes in patients with MINOCA. We aimed to investigate the relationship between sex differences and outcomes of patients with MINOCA.
A systematic literature search was performed in PubMed, Embase, and Cochrane databases from their inception until August 2023 for relevant studies. End points were pooled using the Hartung-Knapp-Sidik-Jonkman random-effects model as odds ratio (OR) with 95% CIs. Nine studies, involving 30 281 patients with MINOCA (comprising 18 079 women and 12 202 men), were included in the study. Women were older and had a higher prevalence of hypertension, diabetes, and stroke compared with men. The median duration of follow-up was 3.5 years, with an interquartile range of 2.2 to 4.2 years. Pooled analysis revealed no statistically significant difference in the risk of all-cause mortality (OR, 1.03 [95% CI, 0.87-1.22]), major adverse cardiovascular events (OR, 1.18 [95% CI, 0.89-1.58]), heart failure (OR, 1.32 [95% CI, 0.57-3.03]), stroke (OR, 1.13 [95% CI, 0.56-2.26]), and myocardial infarction (OR, 1.04 [95% CI, 0.29-3.76]) between the 2 groups. Regarding short-term outcomes, women had a significantly higher risk of in-hospital major adverse cardiovascular events compared with men (OR, 1.33 [95% CI, 1.16-1.53]) whereas there was no significant difference in the risk of in-hospital mortality (OR, 0.90 [95% CI, 0.64-1.28]) between the 2 patient groups.
Despite the differences in demographics and comorbidity profiles, there was no significant difference in the long-term outcomes for patients with MINOCA between sexes. However, it is noteworthy that women experienced a higher risk of in-hospital major adverse cardiovascular events compared with men.
虽然非阻塞性冠状动脉心肌梗死（MINOCA）在女性中更为常见，但尚不清楚性别是否是 MINOCA 患者不良结局的危险因素。我们旨在研究性别差异与 MINOCA 患者结局之间的关系。
系统检索 PubMed、Embase 和 Cochrane 数据库，检索时间从建库至 2023 年 8 月，检索内容为 MINOCA 相关研究。采用 Hartung-Knapp-Sidik-Jonkman 随机效应模型计算比值比（OR）及其 95%置信区间（CI）作为汇总结果。
共纳入 9 项研究，共计 30281 例 MINOCA 患者（包括 18079 例女性和 12202 例男性）。女性年龄较大，且高血压、糖尿病和卒中等合并症的患病率高于男性。中位随访时间为 3.5 年，四分位间距为 2.2 年至 4.2 年。汇总分析显示，两组患者的全因死亡率（OR，1.03[95%CI，0.87-1.22]）、主要不良心血管事件（OR，1.18[95%CI，0.89-1.58]）、心力衰竭（OR，1.32[95%CI，0.57-3.03]）、卒中和心肌梗死（OR，1.04[95%CI，0.29-3.76]）风险无统计学差异。关于短期结局，女性院内发生主要不良心血管事件的风险显著高于男性（OR，1.33[95%CI，1.16-1.53]），但两组患者院内死亡率（OR，0.90[95%CI，0.64-1.28]）差异无统计学意义。
尽管两组患者的人口统计学和合并症特征存在差异，但性别对 MINOCA 患者的长期结局无显著影响。然而，值得注意的是，与男性相比，女性发生院内主要不良心血管事件的风险更高。
