Sex Differences in ICU Assignment and Mechanical Ventilation for Patients with Myocardial Infarction

Background: We aimed to examine sex-related differences in the allocation of intensive care and mechanical ventilation among patients with myocardial infarction. Understanding these differences may help identify potential disparities in critical care delivery and inform efforts to promote equitable treatment allocation. Methods: We conducted a retrospective cohort study using the publicly available MIMIC-IV database, which contains de-identified electronic health records of ICU patients. We identified all adult patients (≥20 years) admitted to any ICU with a diagnosis of acute myocardial infarction using ICD codes. This study uses the denormalized MIMIC-IV ICU database to examine the hourly progression of patient treatments and outcomes. Results: Women with MI were less likely than men to be admitted to cardiac specialty ICUs and had significantly higher mortality and lower odds of receiving mechanical ventilation. Patterns of ICU assignment revealed notable sex disparities as well. Women admitted with MI were less likely than men to be assigned to the CVICU but more likely to be placed in the Neuro-Intermediate ICU. The differences observed in this study may reflect the higher prevalence of atypical symptom presentation in women, which can lead to misdiagnosis and subsequent admission to non-specialty ICUs, including those oriented toward neurological conditions. Conclusion: The observed differences in ICU distribution do not establish their underlying causes, because the clinical indications and decision-making processes underlying ICU assignment were not evaluated. These real-world findings highlight the need to examine how sex influences ICU placement, and to consider policy and practice changes that reduce these biases.