Milewski Marek, Desperak Aneta, Koźlik Maciej, Bujak Marta, Gierlotka Marek, Milewski Krzysztof, Wita Krystian, Kalarus Zbigniew, Fluder-Włodarczyk Joanna, Buszman Pawel E, Piegza Jacek, Mamas Mamas A, Wojakowski Wojciech, Gasior Pawel
Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
Department of Cardiology, School of Medicine, Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Zabrze, Poland.
Sci Rep. 2025 Jan 22;15(1):2764. doi: 10.1038/s41598-025-87121-5.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes 3-15% of all acute myocardial infarctions. Women are more frequently diagnosed with MINOCA, although the influence of sex on long-term outcomes is still unclear. In this study we aimed to compare sex-based differences in baseline characteristics and clinical outcomes in patients with suspected MINOCA. We have retrospectively analyzed 6063 patients diagnosed with MINOCA (3220 females and 2843 male patients) from combined 3 large polish registries (PL-ACS, SILCARD and AMI-PL). Male patients were significantly younger (63 (55-74) vs. 71 (61-79) years, p < 0.05) and less frequently diabetic (20.1% vs. 24.1%, p < 0.05). Mortality was significantly higher in male population (11.8% vs. 10.2%, p < 0.05 at 1 year and 17.6% vs. 15.0%, p < 0.05 at 3 years). Male sex was an independent predictor of both mortality (HR = 1.29; CI 1.11-1.51; p < 0.05) and myocardial infarction (HR = 1.39; CI 1.1-1.75, p < 0.05) at 3 years follow-up. All-cause readmission rates were similar in male and female patients both at 1 year (46.0% vs. 44.4, p = 0.2) and 3 years follow-up (56.4% vs. 56.5%, p = 0.93). However, cardiovascular readmissions were more prevalent in male patients at both timepoints (33.9% vs. 29.10%, p < 0.05 at 1 year, and 41.0% vs. 37.6%, p < 0.05 at 3 years). This large-scale registry-based analysis demonstrated higher 3 years rates of adverse events, including death and MI among male patients with suspected MINOCA.
非阻塞性冠状动脉心肌梗死（MINOCA）占所有急性心肌梗死的3%-15%。女性被诊断为MINOCA的频率更高，尽管性别对长期预后的影响仍不明确。在本研究中，我们旨在比较疑似MINOCA患者基线特征和临床结局的性别差异。我们回顾性分析了来自波兰3个大型注册库（PL-ACS、SILCARD和AMI-PL）的6063例诊断为MINOCA的患者（3220例女性和2843例男性患者）。男性患者明显更年轻（63（55-74）岁 vs. 71（61-79）岁，p<0.05），糖尿病患者较少（20.1% vs. 24.1%，p<0.05）。男性人群的死亡率明显更高（1年时为11.8% vs. 10.2%，p<0.05；3年时为17.6% vs. 15.0%，p<0.05）。男性性别是3年随访时死亡率（HR=1.29；CI 1.11-1.51；p<0.05）和心肌梗死（HR=1.39；CI 1.1-1.75，p<0.05）的独立预测因素。1年和3年随访时，男性和女性患者的全因再入院率相似（1年时为46.0% vs. 44.4%，p=0.2；3年时为56.4% vs. 56.5%，p=0.93）。然而，在两个时间点，男性患者的心血管再入院更为普遍（1年时为33.9% vs. 29.10%，p<0.05；3年时为41.0% vs. 37.6%，p<0.05）。这项基于大型注册库的分析表明，疑似MINOCA的男性患者3年不良事件发生率更高，包括死亡和心肌梗死。
