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Sex Differences in Ventricular Arrhythmias and Outcomes After AMI
Quick Takes
- Men are more likely to have ventricular arrhythmias (VAs) after type 1 AMI during their hospital admission.
- Women are more likely to have worse outcomes such as in-hospital mortality, cardiogenic shock, and cardiac arrest.
- Women are also less likely to receive ICD placement after VAs from AMI as compared to men.
Study Questions:
What are the sex differences in the incidence and in-hospital outcomes of patients with acute myocardial infarction (AMI) and ventricular arrhythmias (VAs)?
Methods:
VAs are a common cause of death in patients with AMI. Studies have shown sex differences in the incidence, presentation, and outcomes of AMI. However, less is known about sex differences in patients with AMI who develop VA. Using the National Inpatient Sample (NIS) 2016–2020, the authors conducted a retrospective analysis of patients admitted for AMI with a secondary diagnosis of VA. Multivariable logistic regression was performed to estimate the sex-specific differences in the rates and in-hospital outcomes of VAs post-AMI. The NIS is the largest publicly available all-payer inpatient database in the United States and is maintained by the Agency for Healthcare Research and Quality, it is designed as a stratified probability sample of discharges representing nonfederal acute care hospitals nationwide. Samples from these hospitals are recorded and then weighted to ensure that they are nationally representative.
The study population included patients who had type 1 AMI and were admitted to the hospital for management. The sociodemographic variables and presentation were compared between the two groups. The primary endpoint of this study was to determine the sex differences in the rates of VA among patients with AMI, while the secondary outcomes were sex differences in rates of in-hospital mortality, cardiogenic shock, cardiac arrest, implantable cardiac defibrillator (ICD) insertion, palliative care consultation, catheter ablation, and length of hospitalization.
Results:
Of the 1,543,140 patients admitted with AMI, 11.3% of patients had VA after AMI. The odds of VA after AMI were higher among men (12.6 vs. 8.8%, adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.67–1.78). Women had significantly higher odds of in-hospital mortality (aOR, 1.32; 95% CI, 1.21–1.42; p < 0.001), cardiogenic shock, and cardiac arrest, and were less likely to receive an ICD and undergo catheter ablation.
Conclusions:
The authors report there are significant sex- and gender-based differences in patients with AMI and VAs. Women were less likely to have VAs after AMI but those who did were less likely to receive an ICD and had worse outcomes in terms of cardiogenic shock, cardiac arrest, and sudden death.
Perspective:
VAs including ventricular tachycardias (VTs) occur in about 10-20% of the population with AMI. These patients tend to have worse outcomes such as cardiogenic shock, cardiac arrest, and decompensated heart failure. Previous studies have explored sex differences but this study from NIS explores these data from a large, nationally represented dataset and sex differences were explored in detail. Despite less likely presentation of VA after type 1 AMI in women, they were less likely to receive ICD placement and had worse outcomes. This study highlights that while ICD placement continues to be standard of care as secondary prevention in VT in those with AMI, women are less likely to receive this evidence-based treatment. Future studies need to explore the contributions as to why women are less likely to have VAs than men and address gaps in care.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Sex Characteristics
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