When STEMI strikes early: exploring gender differences in patients younger than 50

ST-segment elevation myocardial infarction (STEMI) in people under 50 years of age represents a particular clinical subgroup. Our objective was to analyze clinical, angiographic, and prognostic differences in individuals under 50 years of age according to sex.

Retrospective observational study of patients under 50 years admitted for STEMI between 2017 and 2023 at our center. Baseline characteristics, infarction characteristics, and follow-up events were analyzed according to sex.

During the period between 2017 and 2023, 229 patients with STEMI under 50 years were admitted. The mean age was 45.07 ± 5.09 years, 15.28% of patients being women.

Baseline characteristics are described in Table 1. There were no statistically significant differences in classic cardiovascular risk factors between the two groups, except for substance abuse, which was higher in men.

In terms of infarction characteristics, the rate of shock as a complication was significantly higher in women. There were no significant differences in the time of evolution, location of the infarction, ventricular function, or time of admission. There were also no differences in the treatment strategy, although there was a tendency toward less stenting in the women's group. Women had a higher rate of coronary dissection, while in the men's group, the need for a second procedure was more frequent.

The mean follow-up was 3.8 years ± 2. Table 2 shows a summary of the events during follow-up. Twelve patients died in this cohort, seven during admission. The mortality rate was similar in men and women. There were no differences in the incidence of reinfarction or admissions; however, women had a higher rate of stroke.

The incidence of STEMI in people under 50 is higher in men than in women. The profile of the type of heart attack and the strategy sometimes varies according to gender, with the presentation being worse in women. Although there are no clear differences in the time of evolution, these findings underscore the need for strategies to improve the recognition and management of heart attacks in young women.