Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a cohort of older Finnish adults, men had an increased long-term risk of adverse cardiovascular events after a myocardial infarction compared to women.

Evidence Rating Level: 2 (Good)

Myocardial infarctions (MI) are a leading cause of morbidity and mortality worldwide. Despite this, there are limited studies on acute coronary syndromes including older patients. Specifically, although short-term mortality after MI has been studied in this population, there is limited evidence on long-term outcomes. Therefore, this retrospective cohort study aimed to evaluate the sex differences in long-term cardiovascular outcomes after MI in older adults. It made use of data from international registries and all patients with MI >70 years admitted to 20 hospitals were followed for a 10-year period. The studied included 31,578 patients (59% men; mean age = 79 years). All outcomes were measured for 10 years, beginning at 90 days after index MI. The primary outcome measured was a composite major adverse cardiovascular event (MACE) such as new MI, ischemic stroke, or cardiovascular death. It was found that MACE occurred in 8508 men and 7620 women during the follow-up period. The incidence of MACE was 18.6% in men versus 15.8% in women after the 1-year follow-up (p < 0.0001), 47.0% in men versus 41.9% in women after the 5-year follow-up (p < 0.0001), and 67.7% in men versus 62.0% in women at the end of the 10-year follow-up (hazard ratio (HR), 1.17; 95% CI, 1.13 – 1.21, p < 0.0001). The secondary outcomes measured were cardiovascular death, new MI, and ischemic stroke. At the 10-year follow-up, the incidence of new MI was 37.0% in men and 33.1% in women (HR, 1.16; CI, 1.11–1.21; p < 0.0001). Similarly, the incidence of cardiovascular death was 56.0% in men versus 51.1% in women at the10‐year follow‐up (HR, 1.18; CI, 1.13–1.22; p < 0.0001). Lastly, the incidence of ischemic stroke was 21.1% in men versus 19.5% in women at 10 years (HR, 1.10; CI, 1.03–1.18; p = 0.004). Therefore, the study concluded older men had worse long-term cardiovascular prognoses after MI compared to women. This well-designed and well-powered study brings forward new information that may impact clinical decision-making in the future.

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