What is the clinical evidence from this study?

Study design: Observational. Population: Non-ST-elevation myocardial infarction (n=4911). Primary outcome: Major adverse cardiac and cerebrovascular events (MACCE) and Major adverse cardiac events (MACE) (HR 1.20, 95% CI 1.03–1.40, p=<0.001).

March 12, 2026Open Access

Impact of sex differences on revascularization and long-term clinical outcomes in patients with non-ST-elevation myocardial infarction: a multicentre study from China

Q: What are the key findings of this study?

Women with non-ST-elevation myocardial infarction had an increased risk of major adverse cardiac and cerebrovascular events (MACCE) with an HR of 1.20 compared to men, strongly linked to lower rates of revascularization in women.

Q: What question did this study set out to answer?

This research examines the impact of sex differences on revascularization and long-term clinical outcomes in NSTEMI patients.

Key Result

Women with non-ST-elevation myocardial infarction had an increased risk of major adverse cardiac and cerebrovascular events (MACCE) with an HR of 1.20 compared to men, strongly linked to lower rates of revascularization in women.

Key Points

This research examines the impact of sex differences on revascularization and long-term clinical outcomes in NSTEMI patients.
Multicenter retrospective analysis of NSTEMI patients from five institutions
Assessment of sex differences in revascularization using multivariate logistic regression
Cox regression identified predictors of clinical outcomes
Stratified analyses performed based on revascularization status
Propensity score matching used for sensitivity analysis.
Women were less likely to undergo revascularization (adjusted odds ratio 0.68)
Women had lower survival rates free from major adverse cardiac and cerebrovascular events (P < 0.001)
Women showed increased risk of MACCE (HR 1.20) and MACE (HR 1.30) compared to men
In non-revascularized women, risks were even higher (MACCE: HR 1.30; MACE: HR 1.64)
No significant sex-based differences in outcomes for those who underwent revascularization.

Study Design

Type

Observational (n=4,911)

Multicenter

Yes

Structured PICO

Does female sex increase the risk of major adverse cardiac and cerebrovascular events in patients with NSTEMI compared to male sex?

Population

4,911 adults (>18 years) with a discharge diagnosis of non-ST-elevation myocardial infarction (NSTEMI) (3,506 men; 1,405 women), from 5 institutions in China. Excluded: in-hospital death, end-stage renal failure requiring long-term renal replacement therapy, or history of active malignancy.

Intervention

Female sex (observational analysis of sex differences)

Comparator

Male sex

Outcome

Major adverse cardiac and cerebrovascular events (MACCE; composite of all-cause death, recurrent myocardial infarction, heart failure, stroke, and unplanned repeat revascularization) and major adverse cardiac events (MACE; composite of cardiac death, recurrent myocardial infarction, heart failure, and unplanned repeat revascularization)composite

Main Result

Effect estimate: HR 1.20 (95% CI 1.03–1.40)

p-value: p=<0.001

Limitations

Retrospective design limiting ability to control for all confounders
Lack of outpatient management data
Limited to baseline data at admission

Abstract

The influence of sex differences on the clinical prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI) remains controversial. This multicenter, retrospective study analyzed NSTEMI patients from five institutions. The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and major adverse cardiac events (MACE). Multivariate logistic regression was used to assess sex differences in revascularization. Multivariate Cox regression with stepwise selection identified independent prognostic predictors. Stratified analyses were performed by revascularization status. To strengthen the analytical robustness, propensity score matching (PSM) was employed as a sensitivity analysis, balancing age, comorbidities, and key treatment factors. A total of 4,911 NSTEMI patients (3,506 men; 1,405 women) completed follow-up. Women were less likely to undergo revascularization (adjusted odds ratio 0.68, 95%CI 0.58–0.79). Over a median follow-up of 527 days, women had significantly lower cumulative survival free from MACCE and MACE (both P 0.05). These findings were consistent in the PSM-based sensitivity analysis. The sex-based prognosis difference in NSTEMI is linked to underutilization of revascularization in women. Ensuring equitable guideline-directed revascularization may eliminate this disparity.

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