BSTRACT

Background: Myocardial infarction (MI) survivors' health outcomes must be known in order
to assess each patient's unique needs, facilitate the early diagnosis and treatment of newly
diagnosed conditions, and guide the development of health care plans. MI has a significant role
in the development of other cardiovascular, metabolic, and neuropsychiatric disorders.

Objective(s): To assess the impact of female sex on the incidence, management, and outcomes
of myocardial infarction (MI) in different age groups.

Methodology: The collection of data (observational and comparative analysis) will be

conducted by administering a questionnaire at the Allied hospital Punjab Medical College
Faisalabad. The aim of the survey to asses AMI outcomes and compare analysis by age and
gender. By using a questionnaire, they gathered information from the patients. The data obtained
from the questionnaire will thereafter be examined. The purpose of these surveys is together
comprehensive data across several domains. Data were analyzed in SPSS.

Results: A total of 98 patient’s data received. There was following outcomes of acute
myocardial infarction. A 95(96%) patient was hypertensive and 92(93%) patients was
hyperlipidemia. With diabetes 82(83%) patients and CKD was 72(73%). 47(48%) patients was
previous MI and previous PCI was 48(49%) patients. AMI outcomes was following with great
improved 54(55.4%), with somewhat improved was 22(22.4%) patients and 22(22.4%) patients
which was no changes AMI outcomes.

Conclusion(s): In Pakistan, Allied hospital Punjab medical college Faisalabad the data
showed that men had higher incidence rates of MI than women. Sex differences exist; Future
research should focus on eliminating these sex-related disparities in our health system.

Key words: AMI; Heart failure; acute coronary syndrome; Ischemic heart disease; CKD

1
 CHAPTER 1
INTRODUCTION

Myocardial infarction (MI) survivors' health outcomes must be known in order to assess each
patient's unique needs, facilitate the early diagnosis and treatment of newly diagnosed
conditions, and guide the development of health care plans. MI has a significant role in the
development of other cardiovascular, metabolic, and neuropsychiatric disorders. While assessing
the 10-year risk of cardiovascular disease is a well-established component of primary prevention,
there is a dearth of comprehensive data about the long-term effects of MI on major health
outcomes that follow. (J. A. Batty, P. C. Lambert, , 2024). Interest in the disparities in
cardiovascular disorders between the sexes has long existed. There are gender-based differences
in the incidence, treatment, and prognosis of myocardial infarction (MI). Most research shows a
strong correlation between female sex and poorer outcomes and a lower chance of referral for
invasive therapy (W. Boubas and A. Lerman, 2021). Cardiovascular disease continues to be the
top cause of death in the US, despite improvements in cardiovascular research and therapies and
the corresponding drop in cardiovascular mortality. In the US, the death rate from acute
myocardial infarction (AMI) is still disproportionately high among women. In the US, AMI
claimed the lives of around 74,000 women in 2004. In comparison to their male counterparts,
women who present with AMI also appear to die earlier, according to a number of reports. In
addition, compared to males, women get fewer invasive medical procedures following AMI.
Therefore, we used a sizable modern national database to perform a thorough examination of the
relationship between sex and medical treatment and early mortality following AMI. More
precisely, we compared in a methodical manner the application of early medical interventions,
reperfusion (I. F. Palacios, A. O. Maree,, 2008). The most common form of ischemic heart
disease and the primary cause of death for both men and women worldwide, acute myocardial
infarction (AMI) accounts for 17.9 million fatalities annually (31% of all deaths). Because of
improvements in cardiovascular prevention, pharmaceutical therapy, coronary revascularization,
and improved knowledge of cardiovascular risk, the death rate from ischemic heart disease has
decreased recently. Nevertheless, a number of studies have linked poorer outcomes for women to
a lower prevalence of invasive therapy, such as coronary angiography (CA) or percutaneous
coronary intervention (PCI), and have also revealed a greater frequency of adverse events in
women following AMI (H. G. Van Spall, T. Coutinho,, 2021). One of the most frequent illnesses

2
in the world, acute myocardial infarction (AMI) continues to be one of the leading causes of
mortality for both men and women. It has recently been discovered that female sex is linked to a
worse result in AMI. The evident effect of an older age and an elevated risk profile on mortality
in female patients has been hotly contested up to this point, with conflicting findings in published
data. While certain data indicated that there were no gender-related variations in AMI mortality,
other studies showed that females continued to have poorer outcomes than males even after age
and risk profile adjustments. Furthermore, it has been suggested that undertreating female
patients and delaying diagnosis might worsen their prognosis for AMI (H. Reinecke and K.
Wegscheider, 2018).

Myocardial infarction can act as a harbinger when analyzing sex differences since it is a crucial
predictor of the burden of cardiovascular disease. A number of studies from the 1990s
highlighted significant gender disparities in myocardial infarction outcomes. Nonetheless, there
exists a significant degree of variability and methodological variations across publications
concerning the impact of sex on mortality following myocardial infarction. According to several
studies, the significant extra risk of mortality that was shown in women was reduced when age,
comorbidities, and therapy were taken into account. This suggests that differences in sex were
mostly due to variations in baseline characteristics and care. Other research, on the other hand,
highlighted that only young women had a greater risk of mortality following myocardial
infarction, pointing to pathophysiological differences specific to sex, especially at younger ages.
(A. M. Chamberlain, R. Jiang,, 2021). Over the past three decades, there has been a significant
improvement in survival following myocardial infarction (MI) due to advancements in treatment.
This has led to a subsequent rise in the development of heart failure (HF). There are disparities
between men and women who had MIs in terms of access to care, care received, and clinical
outcomes, according to a number of publications. Early research has shown that women who had
a MI had greater short- and long-term death rates and had fewer revascularization surgeries. (S.
G. Goodman and P. Kaul, 2020). Decades of research have proven in recent years the existence
of gender-based variations in the clinical presentation and prognosis of individuals hospitalized
for acute myocardial infarctions (AMI). In general, women are more prone than males to
experience unusual symptoms and to bear the heavier burden of comorbidity. In addition, they
had longer reperfusion delays, a higher incidence of adverse events such significant bleeding and
problems from vascular access, and a lower likelihood of cardiac catheterization. The typical age

3
of female patients presenting with AMI is older, which has been linked to many of the previously
noted disparities in care, complications, and prognosis (R. P. Dreyer, K. P. Alexander,, 2019).

1.1: RATIONALE

o This study aims to address these gaps in knowledge, providing a comprehensive analysis
of how age and gender influence AMI management and outcomes.
o The findings could lead to more personalized care and better health outcomes for all
patients.

4
 CHAPTER 2
LITERATURE REVIEW

Acute coronary syndrome (ACS), a symptom of ischemic heart disease (IHD), is a leading global
cause of morbidity and death in both men and women. IHD is still the top cause of death in New
Zealand (NZ), despite reducing rates of IHD mortality and ACS hospitalization. Those who have
experienced an ACS are more likely to experience recurring occurrences. It is commonly
recognized that there are gender variations in the course of IHD, but women's heart disease has
received less attention because of the belief that they are not as vulnerable as males. Women
with ACS have greater rates of in-hospital and long-term mortality as well as readmissions, and
they are less likely to get therapy that are indicated by guidelines than males. They also have a
larger load of comorbidities. Men and women have distinct distributions of cardiovascular (CV)
risk factors and comorbidities by age, thus we should take age-specific sex variations in ACS
outcomes into consideration, even though numerous studies have demonstrated that age and
comorbidities account for a major portion of these disparities in outcomes. (C. Riddell, Y. Choi, ,
2024).
As of January 2023, the COVID-19 pandemic has killed over 1,090,000 people in the US. Data
from the Centers for Disease Control and Prevention (CDC) indicate that the pandemic may have
had varying effects on age categories and racial and ethnic groupings in the US. Black and
Hispanic populations have been shown to have higher death rates, while the age range of 65-74
years old has the highest death rate overall. Studies on the consequences of acute myocardial
infarction (AMI) have revealed a similar discrepancy, with middle-aged adults, non-Hispanic
Black adults, and people living in rural areas experiencing greater rates of death than their
counterparts. All sexes, racial and cultural groupings, and geographic regions of the United
States had a decline in AMI death rates between 1999 and 2019, but new research shows that this
trend is reversing in 2020, with an increase in the death rate from cardiovascular disease. While
the precise cause of this increase and the observed differences is yet unknown, the pandemic
most definitely had a significant impact. Multifactorial explanations are probably responsible for
the overall rise in AMI mortality rates. First, there have been reports of delayed reperfusion and
restricted access to healthcare during the lockdown. Secondly, there was a correlation between
the pandemic lockdown and higher rates of alcohol use (20%) and smoking (30%), all of which

5
are established risk factors for cardiovascular disease. Along with variations in the incidence of
cardiovascular risk factors, socioeconomic determinants of health have been implicated in the
widespread discrepancies across various racial and ethnic groups. Additionally, increased
thrombogenicity is linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
infections, particularly in African American individuals, who may have predisposed (S. Duhan,
N. Patel, , 2024). Male and female biological variations have a substantial impact on how
diseases manifest, develop, respond to treatment, and turn out in general. The identification of
sex variations in heart failure (HF) has led to more research on their therapeutic consequences.
Interestingly, women are more likely to be diagnosed with HF with intact ejection fraction than
with HF with reduced ejection fraction. Further investigation is warranted since this
differentiation may be associated with sex-specific variations in a etiology, pathophysiology, and
other risk factors. As a result, there are gender differences in the clinical signs and reactions to
pharmaceutical and non-pharmacological therapies. Furthermore, there is clinical significance in
the fact that female patients with HF tend to be older than their male counterparts. In the medical
domain, age is a widely recognized factor that affects treatment response and clinical results,
offering (J. J. Park, 2024).

STEMI is defined as coronary artery obstruction resulting in Tran’s mural MI, which causes
myocardial infarction and necrosis. In cases of acute STEMI, prompt identification and treatment
can lower morbidity and death. It is still debatable if individuals with acute STEMI have
different outcomes depending on their gender. Compared to their male counterparts, female
STEMI patients often have a greater mean age upon presentation, which increases their chance
of multi-vessel illness. When compared to male patients, the diagnosis and prognosis for female
patients have often been subpar and ignored. Uncertainty surrounds the underlying factors
responsible for female patient mortality. Previous research has revealed that gender differences
exist in clinical and outcome features, with females being more likely than males to have cardiac
risk factors and death. Several studies have shown that female patients with STEMI receiving
PAMI had a greater death rate than male patients; the difference may have been caused by
distinct cardiovascular risk factors. Gender differences in mortality have been seen mostly in
younger and young adult patients; however, there was no gender difference in death in older
patients (V. Sharma, S. Jain,, 2024). Cardiovascular disease is still the leading cause of death in
Europe, affecting 39% of men and 47% of women, despite recent declines in this area.

6
Interestingly, compared to males, women had greater rates of illness and death. Within the first
12 hours following the beginning of symptoms, percutaneous coronary intervention (PCI), a
technique designed to promote early coronary reperfusion, has become the standard of care for
ST-segment elevation acute myocardial infarctions (STEMI). Timely intervention is critical in
the event of STEMI, since any delay in seeking healthcare significantly affects the prognosis.
The time it takes for patients to contact the healthcare system and the time it takes for the system
to respond are the main causes of this delay. Thankfully, the development of care networks
centered on early STEMI therapy has resulted in faster response times and a noticeable rise in the
use of PCI as a therapeutic strategy, which has decreased death rates. There are notable
differences in research on mortality outcomes in STEMI between males and females, and it has
been claimed that women gain somewhat less from such therapy. These discrepancies can be
linked to disparities in clinical symptoms, delays in getting the right therapy, underuse of PCI,
and risk factors unique to a person's gender. Therefore, in order to make meaningful conclusions
about these elements, research that is especially focused on the female gender must be
conducted. This study's main goal is to determine if women experience a longer delay than men
do in cases of STEMI, from the onset of symptoms to the opening of the afflicted artery.
Additionally, the study intends to investigate if, during the follow-up period, this delay is linked
to a greater occurrence of serious adverse outcomes (C. Veiga, L. Busto, S. Fernández-Barbeira,,
2024). According to health statistics, women (60 million) were more likely than men (53 million)
to be diagnosed with cardiovascular disease (CVD) in Europe in 2019. Women also received 6.5
million new diagnoses for CVD, compared to men's 6.1 million, which is consistent with recent
trends seen in the US and other regions of the world. Despite these figures, the persistent belief
that CVD is mostly a "male phenomenon" dates back to Herrick's seminal research in the early
1980s. Furthermore, it is well known that women are under-represented in published research on
cardiovascular diseases (CVDs), especially in clinical trials. As a result, conclusions drawn from
this material are biased.
A growing body of scientific research indicates that women are just as likely as males to develop
CVD, despite variations in symptom and clinical presentations, age of onset, sensitivity to known
risk factors, and responsiveness to medication. Consequently, the vast majority of cardio logical
associations worldwide support the necessity of gender- or sex-centric analysis. Gender, in
particular, affects people's health-related outcomes, restricts access to healthcare, and interacts

7
with other inequalities through societal norms, roles, and behaviors. However, there is still a
large vacuum in the field of CVD epidemiology when it comes to research that examine
variations in sex and gender, particularly when long-term follow-up exams are included.
Therefore, the current study's objectives are to examine gender differences in long-term CVD
incidence (2002–2022) and to consider the possible moderating effect of sex (E. Damigou, F. P.
Tatakis,, 2024). Globally, there is a substantial correlation between the metabolic syndrome
(MetS), which is characterized by the clustering of dyslipidemia, insulin resistance, abdominal
obesity, and high blood pressure, and cardiovascular-related mortality and morbidity. The World
Health Organization (WHO) defines the population-attributable risks of MetS as 17% and 7%,
respectively, for the development of cardiovascular disease (CVD) and death. MetS patients also
have a higher chance of developing pro thrombotic and pro inflammatory states, non-alcoholic
fatty liver disease, and reproductive problems. Some of the most researched factors contributing
to the worldwide growth in the incidence of MetS include modernization and industrialization,
which lead to poor nutrition (i.e., overeating) and decreased levels of daily exercise (i.e.,
sedentary lifestyle). It is unclear if social determinants of health (SDOH), which go beyond
biological sex, have an impact on these shifting patterns. While most research has looked into the
physiological mechanisms involved in the development of MetS, few have looked into the
interaction between biological sex and sociocultural gender. A number of variables are
implicated in the development and management of the components of MetS. Gender includes the
psycho-socio-cultural components of an individual's roles, relationships, identity, and
institutions, including SDOH, and may be linked to the development of MetS, whereas sex refers
to an individual's biological/genetic composition. Additionally, men and females may interact
differently when it comes to gender and other social issues, which reflects the distinct
contributions of the culture or nation in which an individual lives. From a sex-specific
standpoint, women who have MetS are more likely to develop cardiovascular disease (CVD)
than men who have the condition. Males are said to be more at risk of diabetes mellitus and
hypertension among the MetS components, whereas females are more likely to have
dyslipidemia and abdominal obesity. Unlike variables associated to sex, the part gender-related
factors like economic level and educational attainment play in the development of MetS has not
received as much attention and still need more clarification. Indeed, differences in MetS and
CVD squeal development between the sexes may be somewhat explained by gender-related

8
variables. Preventative measures might be developed and used to lower the risk of developing
MetS and, as a result, CVD by understanding their fundamental role in the onset and progression
of MetS. Thus, the goal of this study was to use a prospective cohort design to examine the
influence of gender-related characteristics on the development of MetS in adult males and
females (A. Kautzky-Willer, K. Kublickiene, 2024). A complicated state of systemic hypo
perfusion brought on by heart failure is known as cardiogenic shock. Between 2004 and 2018,
the reported occurrence of cardiogenic shock in the US increased thrice. Acute death rates still
hover around 30–50% even with advancements in diagnosis and treatment. Although acute
myocardial infarction (AMI) has been the focus of most studies on patients experiencing
cardiogenic shock, other diseases are now the most common cause of cardiogenic shock in
cardiac critical care units. Women appear to have a worse prognosis than males in heart failure,
but they may have a similar or even better prognosis in other acute cardiovascular diseases such
out-of-hospital cardiac arrest and ST-elevation myocardial infarction (STEMI).
Likewise, it has been shown that women with severe acute respiratory failure have an increased
risk of mortality and that their ventilator settings may be harmful. Numerous studies examining
the impact of sex on outcomes in cardiogenic shock have been conducted using adjusted
analyses; some have found that women experience greater fatality rates, while others have found
no difference. Similarly, registry data indicate that although observational evidence suggests
women may benefit more from mechanical circulatory support (MCS), women are less likely
than males to obtain it. We attempted to evaluate the association between sex and death and the
use of mechanical circulatory support in this systematic review and meta-analysis, taking into
account potential confounding variables (A. Proudfoot, 2024). Heart failure (HF) is a major
socioeconomic issue and a primary cause of death that has been becoming more commonplace
globally. Still, the prognosis for heart failure is not good. However, we may now offer other
therapies such medication therapy, device therapy, mechanical circulatory support, or heart
transplantation because to recent advancements in innovative medicines and HF methods. In
particular, during the past few decades, there has been a dramatic advancement in
pharmaceutical treatment. It has been documented that β-blockers, renin-angiotensin system
inhibitors (RASi), and mineralocorticoid receptor antagonists (MRA) enhance the prognosis of
individuals with heart failure. Aside from these medications, new research indicates that sodium-
glucose co-transporter 2 inhibitor (SGLT2i) and angiotensin receptor neprilysin inhibitor (ARNI)

9
are effective in improving cardiac function, quality of life, and prognosis of heart failure (HF).
As a result, these drugs have been accepted as the standard of care for HF treatment. For the
treatment of HF, ivabradine and vericiguat are also recommended due to their distinct
mechanisms of action. Patients with heart failure exhibit a range of characteristics and etiologies.
In the past twenty years, a new kind of heart failure known as HF with preserved ejection
fraction (HFpEF) has been identified. It is mostly brought on by diastolic malfunction of the left
ventricle (LV). Recent advancements in cancer therapies and improved prognosis for patients
with advanced cancer have led to the emergence of cardiac dysfunction associated with cancer
therapy. We must select the best course of action and management in this situation, not using a
one-size-fits-all strategy but rather a customized one. The age-adjusted prevalence of heart
failure (HF) is lower in women than in men in the United States. The absolute number of people
with HF is greater in women over the age of 70, and the number of people in this age group
doubled between 1990 and 2019. One of the main characteristics that define the phenotype of HF
patients is biological sex, and there have been several documented sex-related variances among
HF patients. Therefore, in order to provide individualized therapy for HF patients with different
phenotypes, it is imperative to comprehend sex-related distinctions in HF. Therefore, we provide
an overview of the current understanding of the variations in cardiac and clinical phenotypes,
treatment options, and clinical outcomes associated with sex in HF in this review. We also go
over possible explanations for the variations in HF pathophysiology that are connected to sex (R.
Nakazawa, Y. Yumita, A. Taruoka, , 2024).

10
 CHAPTER 3

3.1: OBJECTIVE(S)

 To determine how female sex affects myocardial infarction (MI) incidence, treatment,
and outcomes across different ages.

11
3.3: OPERATIONAL DEFINITION(S)

Myocardial Infarction (MI): The term "myocardial infarction" (MI) describes the death
(infarction) of the heart muscle (myocardium) caused on by ischemia, which or the inadequate
supply of oxygen to the heart tissue.

Angina Pectoris: Angina pectoris, or just angina, is recurring chest pain or discomfort. It
occurs when your heart's pumping chambers aren't receiving enough blood and oxygen.

Coronary Artery Disease (CAD): A medical condition that occurs when the coronary
arteries, which supply the heart with blood and oxygen, constrict or become blocked.

Atherosclerosis: Atherosclerosis is a condition in which the inner lining of an artery becomes

thicker or harder due to a buildup of plaque.

Ischemia: A part of your body having less blood flow than usual is called ischemia.

Percutaneous Coronary Intervention (PCI): A non-invasive, invasive procedure

intended to improve blood flow to the ischemic region and reduce coronary artery narrowing or
blockage.

Acute Coronary Syndrome (ACS): A term used to describe a series of illnesses that
cause the blood supply to the heart muscle to suddenly cease or significantly decrease.

12
 CHAPTER 4
MATERIAL AND METHODS

4.1: Study Design: This study was cross-sectional, observational and comparative analysis.

4.2: Settings: With approval from the institutional ethics committee, data for this study were
gathered from patients at the Allied hospital Punjab Medical College Faisalabad.

4.3: Study Duration: The experiment should take four months to finish.

4.4: Sample Size: Our study sample size is 100.

4.5: Sampling Technique: The sample size of our research study was cross-sectional
and observational.

4.6: Sample Selection:

4.6.1: Inclusion Criteria: Individuals who have an acute myocardial infarction

(AMI) diagnosis while the trial is underway.

4.6.2: Exclusion Criteria: Individuals without informed permission, those with

insufficient medical data, and those having a history of AMI previous to the

research period.

4.7: Equipment(s): As needed for standard care, conventional medical equipment such as ECG
machines, cardiac biomarker tests, and imaging technologies will be used for the diagnosis and
treatment of AMI. Electronic medical records and patient surveys will be used as data gathering
tools to monitor therapy and results.

13
4.8: ETHICAL CONSIDERATIONS
The rules and regulations set by the ethical committee of university of Lahore were followed
while conducting the research and the rights of the research participants were respected.

● Written informed consent attached was taken from all the participants.
● All information and data collection was kept confidential.
● Participants were remained anonymous throughout the study.
● The subjects were informed that there are no disadvantages or risk on the procedure of the
study.
● They were also be informed that they will be free to withdraw at any time during the process
of the study.
● Data was kept in under key and lock while keeping keys in hand. In laptop it was kept under
password.

14
4.9: DATA COLLECTION PROCEDURE
At the Allied Hospital Punjab Medical College Faisalabad, a questionnaire will be given out in
order to gather data. The purpose of the study is to assess how age and gender affect the clinical
outcomes, treatment modalities, and epidemiology of acute myocardial infarction (AMI). They
collected information from the participants using a questionnaire. After then, the information
gathered from the questionnaire will be reviewed. Together, these surveys aim to provide
comprehensive data in a number of fields. Age and gender are among the crucial details that
must be recorded first in order to set the stage for understanding the study's conclusions. To
detect differences in myocardial infarction that is age-stratified and sex-related. Conduct an
observational sampling approach and a small cross-sectional sample to confirm the survey's
validity, reliability, and clarity.

It includes:

 To evaluate the replies, apply statistical methods. Examine age and sex-related
differences as well as demographic factors for trends and relationships.
 • Data gathering instruments (questionnaires/Performa)

15
4.10: DATA ANALYSIS PROCEDURE

SPSS version 25.0, Microsoft Word, and Microsoft Excel were used to analyses the data. We
used both inferential statistics like chi squares and t-tests and descriptive statistics like frequency,
percentage, bar graphs, and pie charts for the goal of data analysis.

16
 CHAPTER 5
RESULTS

Our research included individuals from various age brackets, spanning from <35 to
>60 years old. The majority of participants in our research were between the age
ranges of 46 to 60 years. Table 5.1 and image 5.1 show the frequency and distribution
of persons across various age groups.

Socio-demographic characteristics:
Table5.1: Distribution of individuals in different age groups.

Age Frequency Percent

V <35 3 3.1
a 36-45 25 25.5
l 46-60 50 51.0
i
>60 20 20.4
d
Total 98 100.0

Figure 5.1: Distribution of individuals in different age groups

17
Our research comprised individuals of both genders. Out of the total of 379 participants the
number of females was 231 and the males are 148. The gender distribution of participants in our
investigation is illustrated in Table 5.2 and Figure5.2.

Table 5.2: Gender distribution of participants

Gender Frequency Percent

V Female 21 21.4
a
l
Male 77 78.6
i
d
Total 98 100.0

Figure 5.2: Gender distribution of participants

18
 Table 5.3: Clinical risk profile

Clinical Risk Profile

Answer [n(%)]

Questions Yes (%) No (%)

Hypertension 95(96.9%) 3(3.1%)

Hyperlipidemia 92(93.9%) 6(6.1%)

Diabetes mellitus 82(83.7%) 16(16.3%)

Tobacco use 50(51.0%) 48(49.0%)

Chronic kidney disease (CKD) 72(73.5%) 26(26.5%)

Previous stroke 72(73.5%) 26(26.5%)

Previous MI 47(48.0%) 51(52.0%)

Previous PCI 48(49.0%) 50(51.0%)

Family history of heart disease 8(8.2%) 90(91.8%)

Table 5.4: AMI Outcomes

How has Greatly Somewhat No Change
your quality improved improved
of life been
affected
following
your AMI?
54(55.1%) 22(22.4%) 22(22.4%)

19
Figure 5.3: AMI outcomes quality of life been affected.

Figure 5.4: AMI outcomes quality of life been affected on different ages.
Table 5.5: Association between socio-demographic characteristics and clinical
risk profile.

20
 Characteristics n Hypertension Hyperlipidemia Diabetes
mellitus
(n=95) (n=92) (n=82)

Age

<35 3 3(100%) 3(100%) 3(100%)

36-45 25 23(92%) 21(84%) 20(80%)
46-60 50 50(100%) 48 (96%) 41(82%)
>60 20 19(95%) 20(100%) 18(90%)

Gender

Male 77 74(96.1%) 71(92.0%) 65(84.4%)

Female 21 21(100%) 21(100%) 17(80.9%)

Table 5.6: Socio-demographic characteristics and clinical risk profile.

Characteristics n Tobacco use CKD Previous stroke Previous MI

(n=50) (n=72) (n=72) (n=47)

Age

<35 3 2(66.6%) 3(100%) 2(66.6%) 3(100%)

36-45 25 12(48%) 12(48%) 13(52%) 5(20%)
46-60 50 25(50%) 44(88%) 41(82%) 28(56%)
>60 20 11(55%) 13(65%) 16(80) 11(55%)

Gender

Male 77 42(54.5%) 55(71.4% 56(72.7%) 34(44.1%)

Female 21 8(38%) 17(80%) 16(76.1%) 13(61.9%)

21
 CHAPTER 6
DISCUSSION

Our aim is to find out how age and sex affect acute myocardial infarction treatment and
outcomes. The incidence of myocardial infarction, adjusted for age and sex, rose from 274 cases
per 100,000 person-years in 1999 to a peak of 287 cases per 100,000 person-years in 2000. After
that, the incidence fell every year, accomplishing 208 cases per 100,000 person-years in 2008 (a
24% decrease from 1999 to 2008) (Robert W. Yeh, 2010). Among male people of the ARIC
community who are 35 to 54 years old, the yearly incidence of AMI hospitalizations decreased
between 1995 and 2014. In contrast, women between the ages of 35 and 54 did not show a
decreased incidence of hospitalizations for AMI. Both sexes showed indications of population
ageing, with the share of ARIC community members aged 35 to 54 falling over time in
comparison with the total population aged 35 to 74 (Sameer Arora, 2018). A well-established
body of research shows that women experienced worse in-hospital and long-term outcomes
following an acute coronary syndrome throughout the whole MI population of all ages, despite
the paucity and conflicting evidence about juvenile MI cohorts. Based on groundbreaking
analyses of administrative data pertaining to patients less than 60 years of age treated in the early
1990s, some research found higher 2-year and in-hospital mortality among women, while others
did not. Similarly, more recent prospective registries that intentionally overenrolled younger
female patients do not provide any evidence of sex-related differences in severe adverse
cardiovascular events after a year. After controlling for established risk factors, the women in our
cohort had a 30% decreased likelihood of having a lipid (Ardissino, 2022).

There are particular distinctions between industrialized nations like China. Females with STEMI
who undergo PCI have a significantly increased risk of short-term non-cardiac arrest (NACE) in
industrialized nations. In the current experiment, there was no appreciable change in the short-
term risk among Chinese patients. There are several reasonable explanations for the difference in
short-term risk between adult females and men of comparable age, especially in light of the
evidence that is now available and our understanding of gender differences in STEMI. Females
with STEMI also tended to be older and to have more comorbidity, including diabetes,
hypertension, chronic renal illness, higher Killip class, and more damaged arteries.

22
In addition, it was shown that sex differences in NACE increased with adjusted age and clinical
characteristics; however, this effect decreased and finally vanished. The hormones direct
protective action on coronary arteries and its impact on cardiovascular disease risk factors
account for the majority of this discrepancy. By promoting the growth of endothelial cells,
inhibiting the migration and expansion of smooth muscle cells, and altering the bioavailability of
nitric oxide produced by endothelial cells, estrogens safeguard the coronary artery system. The
disparity in patient demography (those under 60) and AMI types may potentially be contributing
factors to this variation among nations. To understand why this study is different from previous
ones, more research is required (Fu, 2018).

23
 CHAPTER 7

7.1: CONCLUSION(S)
In Pakistan, Allied hospital Punjab medical college Faisalabad the data showed that men had
higher incidence rates of MI than women. Sex differences exist; Future research should focus on
eliminating these sex-related disparities in our health system. High mortality of patient’s clinical
risk factor is high. In conclusion, data from our study suggest that men hospitalized for an initial
AMI were 46-60, more likely to have hyperlipidemia; men are more mortality then women
which have CKD and previous MI and Hyperlipidemia.

24
7.2: RECOMMENDATION(S)
Improving public and patient awareness of symptoms that may be connected to MI. minimize or
reduce conditions related to myocardial infarction. There is an obvious need for better medical
education on the risks of acute myocardial infarction. It is also essential to raise public
awareness. Countries with similar issues related to acute myocardial infarction may find our
findings useful. Future studies looking at factors specific to a country that cause acute
myocardial infarction.

25
7.3: LIMITATION(S)
There are many limitations on the study. First, only patients getting treatment at Punjab Medical
College Faisalabad's Allied Hospital was included in the research population. Secondly,
considering the brief period of hospital stay, it is essential to investigate the possibility of gender
inequalities in longer-term, post-discharge mortality. Third, feature a single hospital serving
entire communities.

26
 CHAPTER 8
REFERENCES

Sex-Related Differences in Short- and Long-Term Outcome among Young and Middle-Aged Patients for
ST-Segment Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention.
(2018). MedNexus.

A. Kautzky-Willer, K. Kublickiene, P. (2024). Role of sex and gender-related variables in development of

metabolic syndrome: A prospective cohort study. European Journal of Internal Medicine 2024
Vol. 121 Pages 63-75.

A. M. Chamberlain, R. Jiang,, R. S. (2021). Sex differences in outcomes after myocardial infarction in the
community. The American journal of medicine 2021 Vol. 134 Issue 1 Pages 114-121.

A. Proudfoot, T. A. (2024). Sex differences in treatments and outcomes of patients with cardiogenic
shock: a systematic review and epidemiological meta-analysis. Critical Care 2024 Vol. 28.

Ardissino, M. N.-r.-t.-o. (2022). Sex-Related Differences in Long-Term Outcomes After Early-Onset

Myocardial Infarction.

B. Vogel, A. Chieffo, M. Vidal,, A. V. (2023). Sex-based differences in percutaneous coronary intervention

outcomes in patients with ischaemic heart disease. European Cardiology Review 2023 Vol. 18.

C. Riddell, Y. Choi, , N. G. (2024). Sex differences in outcomes after acute coronary syndrome vary with
age: a New Zealand national study. European Heart Journal: Acute Cardiovascular Care 2024 Vol.
13 Issue 3 Pages 284-292.

C. Veiga, L. Busto, S. Fernández-Barbeira,, P.-S. ..-R.-D. (2024). Sex differences in delay times in ST-
segment elevation myocardial infarction: A cohort study. Medicina Clínica 2024 .

D. L. Brown, J. (2006). Gender–age interaction in early mortality following primary angioplasty for acute
myocardial infarction. The American journal of cardiology 2006 Vol. 98 Issue 9 Pages 1140-1143.

E. Damigou, F. P. Tatakis,, E. C. (2024). Sex-related differences in the 20-year incidence of CVD and its
risk factors: The ATTICA study (2002–2022). American Journal of Preventive Cardiology 2024 Vol.
19 Pages 100709.

Fu, W. X.-r.-a.-t.-a.-s. (2018). Sex-Related Differences in Short- and Long-Term Outcome among Young
and Middle-Aged Patients for ST-Segment Elevation Myocardial Infarction Underwent
Percutaneous Coronary Intervention. MedNexus.

27
H. G. Van Spall, T. Coutinho,, A. M. (2021). Trends of sex differences in clinical outcomes after
myocardial infarction in the United States. CJC open 2021 Vol. 3 Issue 12 Pages S19-S27.

H. Reinecke and K. Wegscheider, E. N. (2018). Nationwide routine‐data analysis of sex differences in

outcome of acute myocardial infarction. Clinical cardiology 2018 Vol. 41 Issue 8 Pages 1013-
1021.

H.-C. Yao, M.-T. L.-L.-J. (2023). Clinical risk factors and outcomes of young patients with acute ST
segment elevation myocardial infarction: a retrospective study. BMC Cardiovascular Disorders
2023 Vol. 23 Issue 1 Pages 353.

I. F. Palacios, A. O. Maree,, H. C. (2008). Sex differences in medical care and early death after acute
myocardial infarction. Circulation 2008 Vol. 118 Issue 25 Pages 2803-2810.

J. A. Batty, P. C. Lambert, , M. (2024). Health outcomes after myocardial infarction: A population study of
56 million people in England. Plos Medicine 2024 Vol. 21 Issue 2 Pages e1004343.

J. A. Suwaidi, W. Almahmeed,, A. K. (2020). Age‐related sex differences in clinical presentation,

management, and outcomes in ST‐segment–elevation myocardial infarction: pooled analysis of
15 532 patients from 7 arabian Gulf registries. Journal of the American Heart Association 2020
Vol. 9 Issue 4 Pages e013880.

J. Faxén, C. Lewinter,, T. J. (2022). Sex-related differences in the management and outcomes of patients
hospitalized with ST-elevation myocardial infarction: a comparison within four European
myocardial infarction registries. European Heart Journal Open 2022 Vol. 2 Issue 4 Pages
oeac042.

J. J. Park, Y. D. (2024). Differential Effect of Sex on Mortality According to Age in Heart Failure. Journal of
the American Heart Association 2024 Pages e034419.

K. Szummer, S. S. Lawesson, , O. M. (2017). Sex differences in treatments, relative survival, and excess
mortality following acute myocardial infarction: national cohort study using the SWEDEHEART
registry. Journal of the American Heart Association 2017 Vol. 6 Issue 12 Pages e007123.

P. A. Villablanca, K. Goel,, T. S. (2018). Contemporary sex-based differences by age in presenting

characteristics, use of an early invasive strategy, and inhospital mortality in patients with non–
ST-segment–elevation myocardial infarction in the United States. Circulation: Cardiovascular
Interventions 2018 Vol. 11 Issue 1 Pages e005735.

R. Fowler and T. Henry, J. T.-L. (2019). Gender-based outcome differences for emergency department
presentation ofnon-STEMI acute coronary syndrome. The American Journal of Emergency
Medicine 2019 Vol. 37 Issue 2 Pages 179-182.

R. Nakazawa, Y. Yumita, A. Taruoka, , A. M.-I. (2024). Sex Differences in Cardiac and Clinical Phenotypes
and Their Relation to Outcomes in Patients with Heart Failure. Journal of Personalized Medicine
2024 Vol. 14 Issue 2 Pages 201.

28
R. P. Dreyer, K. P. Alexander,, M. H. (2019). Sex-based differences in presentation, treatment, and
complications among older adults hospitalized for acute myocardial infarction: the SILVER-AMI
study. Cardiovascular Quality and Outcomes 2019 Vol. 12 Issue 10 Pages e005691.

Robert W. Yeh, M. S. (2010). Population Trends in the Incidence and Outcomes of Acute Myocardial
Infarction. N Engl J Med 2010;362:2155-2165.

S. Duhan, N. Patel, , H. S. (2024). Disparities by sex, race, and region in acute myocardial infarction-
related outcomes during the early COVID-19 pandemic: the national inpatient sample analysis.
American Journal of Cardiovascular Disease 2024 Vol. 14 Issue 3 Pages 153.

S. G. Goodman and P. Kaul, J. F. (2020). Is there a sex gap in surviving an acute coronary syndrome or
subsequent development of heart failure? Circulation 2020 Vol. 142 Issue 23 Pages 2231-2239.

Sagris, M. T. (2024). Young and older patients with acute myocardial infarction: differences in risk
factors and angiographic characteristics. Hellenic Journal of Cardiology.

Sameer Arora, M. G.-N. (2018). Twenty Year Trends and Sex Differences in Young Adults Hospitalized
With Acute Myocardial Infarction. AHAIASA JOURNALS.

V. Hernandez-Barrera, J. de Miguel-Díez, N. Muñoz-, J.-Y. R.-G. (2021). Sex differences in the incidence
and outcomes of acute myocardial infarction in Spain, 2016–2018: a matched-pair analysis.
Journal of Clinical Medicine 2021 Vol. 10 Issue 8 Pages 1795.

W. Boubas and A. Lerman, M. H. (2021). Age-stratified sex-related differences in the incidence,

management, and outcomes of acute myocardial infarction. Mayo Clinic Proceedings 2021.

Y. K. Ahn, W. S. Chung, , J. D. (2010). Gender differences in clinical features and in‐hospital outcomes in
ST‐segment elevation acute myocardial infarction: from the Korean acute myocardial infarction
registry (KAMIR) study. Clinical Cardiology 2010 Vol. 33 Issue 8 Pages E1-E6.

Y. R. Wong, D. G. Mikhail, L. S. Ott,, N. E. (2011). Gender differences in presentation, management, and

in-hospital outcomes for patients with AMI in a lower-middle income country: evidence from
Egypt. PloS one 2011 Vol. 6 Issue 10 Pages e25904.

29
9.2: CONSENT FORMS

CONSENT FORM IN ENGLISH

Description of the Research and Your Participation

You are invited to participate in a research study conducted by______________.

The purpose of this research is to evaluate the “_____________________________”.

Risks and Discomforts

Mention if there will be any known risks associated with this research.

Potential Benefits
Mention if there will be benefits to the participant that would result from their participation in
this research.

Protection of Confidentiality
We will do everything we can to protect your privacy. Your identity will not be revealed in any
publication resulting from this study.

Voluntary Participation
Your participation in this research study is voluntary. You may choose not to participate and you
may withdraw your consent to participate any time. You will not be penalized in any way should
you decide not you participate or to withdraw from this study.

CONSENT
I have read this consent form and have been given the opportunity to ask questions.
I give my consent to participate in this study.
Participant’s Signature __________________ Date: ____________________
A copy of this consent form should be given to the participant.

30
 ‫شمولیت کی دعوت دیتا ‪/‬دیتی ہوں میں شرکت کا دعوت نامہ تحقیق‬

‫‪:‬عنوان‬

‫۔ نقصانات اور تکلیف‪ :‬اس تحقیق سے کسی قسم کے نقصان یا تکلیف کا اندیشہ نہیں ہے‬

‫۔ممکنہ فوائد‪ :‬آپکو ایک اہم تحقیق میں حصہ لینے کا موقعہ دیا جاۓ گا‬

‫رازداری کا تحفظ‪ :‬ہم آپ کی معلومات کے تحفظ کے لیے وہ سب کچہ کریں گے جو ہم کر سکتے ہیں۔ تحقیق کے متعلق اکٹہی کیی‬
‫گیی تمام معلومات کو انتہا ئی خفیہ رکھا جاے گا۔ ڈیٹا انٹری اور تجزیے کے دوران آپ کے متعلق وہ تمام معلومات جن سے آپ کی‬
‫شناخت ہو سکتی ہو کو ختم کر دیا جاے گا۔ اس تحقیق کے نتیجے میں شائع ہونے والی کسی بھی اشاعت میں آپ کی شناخت کو‬
‫۔ظاہر نہیں کیا جاے گا‬

‫رضاکارانہ شمولیت‪ :‬اس تحقیقی مطالعہ میں آپ کی شرکت رضاکارانہ ہے۔ آپ کو شرکت نہ کرنے اور کسی بھی وقت پغیر وجہ‬
‫بتانے اس تحقیق میں شمولیت کو چھوڑنے کا اختیار ہے۔ شرکت نہ کرنے یا اس میں شمولیت کو چھوڑنے کی صورت میں آپ کے‬
‫خالف کوئی کاروایی نہیں کی جاے گی‬
‫۔درجذیل معلومات تحقیق میں شامل ہونے والوں کے لیے پڑھیں اور ان کا جواب دیے گیے خانوں میں درج کریں‬

‫میں نے معلوماتی شیٹ جو کہ تحقیق کی وضاحت کر رہی ہے کو سمجھ لیا ہےاورمجھے تحققیق کے سواالت کرنے کا موقع دیا گیا ◻‬
‫۔تھا‬
‫◻‬ ‫میں سمجھ گی ا‪/‬گیی ہوں کہ میری شرکت رضاکارانہ ہے اور یہ کہ میں کسی بھی وقت اپنا ارادہ بدل سکتا‪/‬سکتی ہوں اور‬
‫تحقیق سے دستبردار ہو سکتا‪/‬سکتی‬
‫میں سمجھ گیا‪/‬گیی ہوں کہ میرے جوابات خفیہ رکھے جاءیں کے۔ میں محقیقیین کو اس بات کی اجازت دیتا‪/‬دیتی ہوں کے وہ جوابات ◻‬
‫۔کو جانچ سکیں‬
‫میں سممجھ گیا‪/‬گی ہوں کے معلومات میرے نام کے بجاے نمبر کی صورت میں محفوط کی جائیں گی۔ تا کہ میں نتائج کی اشاعت ◻‬
‫کے دوران کسی بھی طرح سے شناخت نہ کیا جا سکوں۔ میں اس بات سے رضامند ہوں کے جو معلومات مجھ سے لی جائہیں گی وہ‬
‫۔تحقیق میں استعمال ہوں گی‬
‫میں اوپر بتا یی گی تحقیق میں شامل ہونے کے لیے رضامند ہوں اور محقیقین کو اپنا پتہ تبدیل ہونے کی صورت میں مطلع کروں ◻‬
‫۔گا‪/‬گی‬

‫رضا مندی‪ :‬میں نے یہ اجازت نامہ پڑھا ہے اور مجھے سوال پوچھنے کا موقع دیا گیا ہے۔ میں اس سٹڈی میں‬
‫۔شرکت کے راضی ہوں‬

‫دستخط____________________ تاریخ‬ ‫___________ شرکت کنندہ کا نام __________________‬

‫____________ اجازت لینے والے کا نام ________________ دستخط ____________________تاریخ‬

‫۔اس اجازت نامہ کی ایک نقل آپکو دی جانی چاہے‬

‫‪31‬‬
9.4: PROFORMA/QUESTIONNAIRE

32