Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p <0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs. 6.6%), longer hospitalizations (12.2 vs. 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%). After adjustment for patient's risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00-1.04; p=0.036). Notably, more men received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p <0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50-0.55; men HR 0.48, 95% CI 0.47-0.50, p^int = 0.014). In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival.

Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.

Background: Inflammatory myopericardial syndrome (IMPS) is a major disease entity, particularly among younger male patients. The simultaneous occurrence of aortitis is uncommon but potentially life-threatening. Case Summary: A 32-year-old male presented with acute tonsillitis, requiring hospitalization due to significant disease progression. During hospitalization, the patient developed dyspnea and angina pectoris. Owing to suspected ST-elevation myocardial infarction, the cardiac catheterization laboratory was activated; however, coronary artery disease was ruled out. Intensive care treatment was initiated due to emerging cardiogenic shock secondary to subsequently diagnosed IMPS. Computed tomography (CT) revealed a fluid halo surrounding the ascending aorta, which, in combination with positron emission tomography (PET)/CT findings, was interpreted as aortitis. As part of the diagnostic investigation, typical causes of IMPS and aortitis were ruled out. However, acute infection with Chlamydia pneumoniae was identified. Following a 10-day course of azithromycin, inflammatory markers resolved, and no residual evidence of IMPS or aortitis was observed on follow-up cardiac magnetic resonance imaging. Discussion: In this case report, acute Chlamydia pneumonia infection was the only identifiable factor potentially associated with the simultaneous occurrence of IMPS and aortitis. Further research is needed to elucidate the underlying pathomechanism and therapeutic options.

Background: Although ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are very similar regarding pathophysiology and clinical treatments, especially NSTEMI comprises a much more heterogenic group of patients and underlying diseases. We therefore aimed to assess the treatments and outcomes of both entities in a large contemporary cohort. Methods: Patients with STEMI and NSTEMI between 01/2010 to 12/2018 were identified from the largest German Health Insurance (AOK, ≈26 million members). Patient demographics, their hospital course, adherence to guideline-directed drug therapy and overall survival were assessed. Results: In total 544,529 patients (mean age 74, IQR 62-82), one third of whom had a STEMI. Chronic kidney disease, peripheral arterial disease, and heart failure were more common in patients with NSTEMI. Patients with STEMI were more likely to get coronary angiograms and percutaneous coronary interventions. Although STEMI more frequently led to cardiogenic shock, the rate of serious cardiac events was lower. Mortality was higher for STEMI only within the first 30 days, whereas long-term survival rates were better. The combination of statins, angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, and oral anticoagulants or antiplatelet agents was associated with higher overall survival in patients with STEMI (hazard ratio [HR] 0.20; 95% confidence interval [95%CI] 0.18 – 0.24; p<0.001) or NSTEMI (HR 0.30; 95%CI 0.28 – 0.33; p<0.001). Nevertheless, the prescription rates decreased over time, particular in patients with NSTEMI. Conclusion: Clear differences between STEMI and NSTEMI were observed regarding short-and long-term survival. Guideline-recommended therapy improved long-term survival, but decreased during the follow-up period.

Background Although ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are very similar regarding pathophysiology and clinical treatments, especially NSTEMI comprises a much more heterogenic group of patients and underlying diseases. We therefore aimed to assess the treatments and outcomes of both entities in a large contemporary cohort. Methods Patients with STEMI and NSTEMI between 01/01/2010–31/12/2018 were identified from the largest German health insurance (AOK, ≈ 26 million members). Patient demographics, their hospital course, adherence to guideline-directed drug therapy and overall survival were assessed. Results In total 544,529 patients (mean age 74, IQR 62–82), one third of whom had a STEMI. Chronic kidney disease, peripheral arterial disease, and heart failure were more common in patients with NSTEMI. Patients with STEMI were more likely to get coronary angiograms and percutaneous coronary interventions. Although STEMI more frequently led to cardiogenic shock, the rate of serious cardiac events was lower. Mortality was higher for STEMI only within the first 30 days, whereas long-term survival rates were better. The combination of statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta blockers, and oral anticoagulants or antiplatelet agents was associated with higher overall survival in patients with STEMI (hazard ratio [HR] 0.21; 95% confidence interval [95%CI] 0.20–0.23; p < 0.001) or NSTEMI (HR 0.40; 95%CI 0.38–0.42; p < 0.001). Nevertheless, the prescription rates decreased over time, particular in patients with NSTEMI. Conclusion Clear differences between STEMI and NSTEMI were observed regarding short- and long-term survival. Guideline-recommended therapy improved long-term survival, but decreased during the follow-up period.