MedicalResearch.com Interview with:
Nathaniel Smilowitz, MD
Fellow, Cardiovascular Disease
NYU Langone Medical Center
MeicalResearch: What is the background for this study? What are the main findings?
Dr. Smilowitz: Myocardial infarction (MI), commonly known as a heart attack, is a leading cause of death worldwide. In the majority of patients with MI, examination of the coronary blood vessels by angiography reveals an obstruction that limits blood flow to the heart muscle. However, some patients develop MI with non-obstructive coronary arteries (MINOCA) at angiography. This condition is identified more commonly in younger patients and women, and in prior studies, in-hospital death after MINOCA was lower than for MI with obstructive coronary artery disease (MI-CAD). Despite favorable outcomes associated with MINOCA, young women paradoxically have overall higher in-hospital death after MI in comparison to younger men. Although sex differences in post-MI mortality are known to vary with age, the interaction between age, sex, and the presence of obstructive coronary artery disease at angiography on death post-MI had not been previously established.
In this study, we confirmed that in-hospital mortality is lower after MINOCA than MI-CAD and that women are more likely to have MINOCA than men. No sex difference in mortality was observed among patients with MINOCA, but women of all ages had significantly higher mortality after MI-CAD than men. With advancing age, mortality increased to a greater degree in patients with MI-CAD than MINOCA and in men vs. women.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Smilowitz: This is the largest study to explore relationships between age, sex, and obstructive coronary disease on in-hospital death after MI. MINOCA was associated with lower mortality than MI-CAD for all age/sex subgroups. Among patients with MINOCA, there was no difference in mortality by sex. In contrast, women with MI-CAD had an increased risk of mortality in comparison to men.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Smilowitz: Additional efforts are necessary to reduce mortality in women who present with MI-CAD. Further investigation of sex differences in pathophysiology, associated conditions, and disparities of care are warranted. Although the risk of death with MINOCA was lower than MI-CAD, it was not negligible, and future research efforts are necessary to improve our understanding of the mechanisms of MINOCA so that optimal therapies can be targeted to this important group as well.
Presented at the 2016 ACC Meeting April 2016
In-hospital Mortality Of Myocardial Infarction By Sex, Age, And Obstructive Coronary Artery Disease Status In The ACTION Registry-GWTG
Nathaniel R. Smilowitz, Asha Mahajan, Matthew Roe, Anne Hellkamp, Karen Chiswell, Martha Gulati, Harmony Reynolds, New York University School of Medicine, New York, NY, USA, Duke Clinical Research Institute, Durham, NC, USA
Nathaniel Smilowitz, MD (2016). Women With Obstructive Coronary Artery Disease Have Higher Mortality Than Men MedicalResearch.com