Gender Features of the Course of Acute Myocardial Infarction Depending on the Functional State of the Kidneys

Abstract

Annotation. Cardiovascular diseases (CVDs) are the cause of a third of deaths in the general population. Ukraine occupies a leading position in terms of mortality from CVDs. Kidney function is one of the factors that determine the prognosis of the course of CVDs, including acute myocardial infarction (AMI). Traditionally, AMI is associated with the male sex. The course of AMI has its own characteristics in females. Given the strong scientific and practical interest in the problems of studying the gender features of the course of STEMI, especially taking into account the functional state of the kidneys, we conducted a single-centre study, the purpose of which was to study the features of the clinical course of STEMI depending on the functional state of the kidneys in males and females. This study was an open-label observational comparative randomized trial involving 286 patients with STEMI who were urgently hospitalized at Vinnytsia Regional Clinical Medical and Diagnostic Centre for Cardiovascular Pathology MNE during 2021–2023 and underwent urgent revascularization. Patients aged 39 to 87 (mean 62.8±9.8, median age 64, and interquartile range 56 and 71 years) were included in the study. The distribution of patients into different age gradations was carried out according to the WHO recommendations (2015). These data indicate that approximately half of the subjects were elderly patients (53.5%, n=153) and a third were middle-aged patients (30.4%, n=87). The proportion of senile patients did not exceed 12% (11.9%, n=34), and of young patients did not exceed 5% (4.2%, n=12). The gender distribution showed that 202 (70.6%) persons among the examined were male and 84 (29.4%) were female, respectively. The ratio of males to females was 2.4 to 1.0, which demonstrated a significant advantage of men over women among the population of patients examined (p<0.0001 according to the χ2 criterion for dependent samples). The GFR value calculated by the CKD-EPI formula (age, sex, and plasma creatinine level in μmol/L were taken into account in the calculation) in the examined STEMI patient cohort ranged from 15.6 to 87.4 and averaged 51.0±14.3 ml/min∙m2.7 (median of 51.9 and interquartile range 41.0 and 60.6 ml/min∙m2.7). According to the GFR value, 4 representative groups of patients were identified. The 1st group included patients with a calculated GFR value of > 60 ml/min∙m2.7 (category G 2); the 2nd group included patients with GFR within 60–45 (G 3A); the 3rd group included patients with GFR within 44–30 (G 3B), and the 4th group included patients with a GFR value < 30 ml/min∙m2.7 (G 4). Patients with category G 5 (GFR < 15 mL/min∙m2.7) were not included in the study. According to the groups identified, a further comparative analysis of various sex-age and clinical indicators was carried out. Statistical analysis of the results obtained using the STATISTICA 6.1 statistical software package version No. BXXR901E246022FA and Microsoft Excel. Group 1 is represented only by males, average age of 56 (51; 62) years. Group 2 included 92 males (82.1%) and 20 females (17.9%), the average age of patients in this group was 64 (57; 71) years. In group 3, there is an increase in the number of females, in particular, there were 29 males (37.7%) and 48 females (62.3%), the average age was 67 (62; 74) years. The same trend is observed in group 4, namely, there were only 5 males (23.8%), while there were 16 females (76.2%), the average age was 71 (68; 75) years. Comparative analysis of clinical data of patients with STEMI by sex showed that males, compared with females, were younger, had, respectively, a significantly shorter duration of hypertensive history—a significantly higher proportion of patients with hypertension lasting up to 5 years (49.7% vs 32.5%, p=0.01) and lesser proportion from 10 to 20 years (21.6% vs 41.3%, p=0.001 according to the χ2 criterion for independent groups), had a lower incidence of type II diabetes mellitus (18.3% vs 28.6%, p=0.05) and a shorter diabetic history – a decrease in type II diabetes mellitus from 5 to 10 years (9.9% vs 20.2%, p=0.02). Males with STEMI were significantly more likely to smoke than females (40.1% vs 6.0%, p<0.0001). Thus, our analysis allows us to state that the decrease in GFR is associated with the female sex and significantly associated with the increase in the age of patients in general. Among females, there is an increase in the proportion of people with stage II and III hypertension, as well as the proportion of people with a history of coronary artery disease established before the index event. At the same time, the duration of the ischaemic history did not significantly differ. No difference was found between males and females in the localization of coronary artery disease. It was found that the proportion of women with a two-vessel disease increased.