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Ravn-Fischer A, Perers E, Karlsson T, Caidahl K, Hartford M. Seventeen-Year Mortality following the Acute Coronary Syndrome: Gender-Specific Baseline Variables and Impact on Outcome. Cardiology 2019; 143:22-31. [PMID: 31352455 DOI: 10.1159/000501166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated. OBJECTIVES To assess long-term mortality and explore its association with the baseline variables in women and men. METHODS We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months. RESULTS At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender. CONCLUSION For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.
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Affiliation(s)
- Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Perers
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Marianne Hartford
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
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Gupta T, Kolte D, Khera S, Agarwal N, Villablanca PA, Goel K, Patel K, Aronow WS, Wiley J, Bortnick AE, Aronow HD, Abbott JD, Pyo RT, Panza JA, Menegus MA, Rihal CS, Fonarow GC, Garcia MJ, Bhatt DL. 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. Circ Cardiovasc Interv 2019; 11:e005735. [PMID: 29311289 DOI: 10.1161/circinterventions.117.005735] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prior studies have reported higher inhospital mortality in women versus men with non-ST-segment-elevation myocardial infarction. Whether this is because of worse baseline risk profile compared with men or sex-based disparities in treatment is not completely understood. METHODS AND RESULTS We queried the 2003 to 2014 National Inpatient Sample databases to identify all hospitalizations in patients aged ≥18 years with the principal diagnosis of non-ST-segment-elevation myocardial infarction. Complex samples multivariable logistic regression models were used to examine sex differences in use of an early invasive strategy and inhospital mortality. Of 4 765 739 patients with non-ST-segment-elevation myocardial infarction, 2 026 285 (42.5%) were women. Women were on average 6 years older than men and had a higher comorbidity burden. Women were less likely to be treated with an early invasive strategy (29.4% versus 39.2%; adjusted odds ratio, 0.92; 95% confidence interval, 0.91-0.94). Women had higher crude inhospital mortality than men (4.7% versus 3.9%; unadjusted odds ratio, 1.22; 95% confidence interval, 1.20-1.25). After adjustment for age (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) and additionally for comorbidities, other demographics, and hospital characteristics, women had 10% lower odds of inhospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.89-0.92). Further adjustment for differences in the use of an early invasive strategy did not change the association between female sex and lower risk-adjusted inhospital mortality. CONCLUSIONS Although women were less likely to be treated with an early invasive strategy compared with men, the lower use of an early invasive strategy was not responsible for the higher crude inhospital mortality in women, which could be entirely explained by older age and higher comorbidity burden.
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Affiliation(s)
- Tanush Gupta
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Dhaval Kolte
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Sahil Khera
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Nayan Agarwal
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Pedro A Villablanca
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Kashish Goel
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Kavisha Patel
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Wilbert S Aronow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Jose Wiley
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Anna E Bortnick
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Herbert D Aronow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - J Dawn Abbott
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Robert T Pyo
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Julio A Panza
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mark A Menegus
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Charanjit S Rihal
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Mario J Garcia
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
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Araújo C, Laszczyńska O, Viana M, Dias P, Maciel MJ, Moreira I, Azevedo A. Calidad del cuidado y mortalidad a 30 días de mujeres y varones con infarto agudo de miocardio. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction. Int J Cardiol 2019; 299:31-36. [PMID: 31300172 DOI: 10.1016/j.ijcard.2019.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sex-specific outcome data following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse cardiac events (MACE). Since mechanistic principles remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation. METHODS In total, 795 ST-elevation MI patients underwent post-interventional CMR imaging. Feature-tracking (CMR-FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster-pump strains (εa). Tissue characterisation included infarct size, microvascular obstruction and area at risk. Primary endpoint was the occurrence of MACE within 1 year. RESULTS Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13-3.42, p = 0.017) but not independently of baseline confounders (p = 0.526) with women being older, more often diabetic and hypertensive (p < 0.001) and of higher Killip-class (p = 0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p = 0.011, εe p < 0.001) but increased systolic ventricular mechanics (GLS p = 0.001, LVEF p = 0.048). While atrial and ventricular function predicted MACE in men only LV GLS and GCS were associated with MACE in women irrespective of confounders (GLS p = 0.036, GCS p = 0.04). CONCLUSION In men ventricular systolic contractility is impaired and volume assessments precisely stratify elevated risks. In contrast, women experience reduced atrial but increased ventricular systolic strain. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE adding incremental value to sex-specific prognosis evaluation.
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Kytö V, Prami T, Khanfir H, Hasvold P, Reissell E, Airaksinen J. Usage of PCI and long-term cardiovascular risk in post-myocardial infarction patients: a nationwide registry cohort study from Finland. BMC Cardiovasc Disord 2019; 19:123. [PMID: 31117956 PMCID: PMC6532224 DOI: 10.1186/s12872-019-1101-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/07/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite currently available treatments, the burden of myocardial infarction (MI) morbidity and mortality remains prominent. The aim of this was to investigate the risk of developing subsequent cardiovascular events in MI patients. METHODS This was an observational, retrospective cohort database linkage study using patient level data from Finland. Cox proportional hazards models were used to assess the association of risk between the preselected covariates and incidence of specific outcomes. The primary endpoints were new MI, stroke, cardiovascular mortality and overall mortality. RESULTS Finnish adult MI patients alive 7 days after discharge in 2009-2012 were included. The study cohort consisted of 32,909 MI patients, of whom 25,875 (79%) survived 12 months without subsequent MI or stroke. ST-elevation MI (STEMI) was associated with lower risk of subsequent MI and overall mortality compared to non-STEMI patients. Percutaneous coronary intervention (PCI) was used two times more often in STEMI patients, but patients with prior stroke were more than two times less likely to have PCI. Dementia/Alzheimer's disease decreased the use of PCI as much as age over 85 years. Female sex was an independent factor for not undergoing PCI (OR 0.75, P < 0.001 compared to men) but was nevertheless associated with lower risk of new MI and mortality (HR 0.8-0.9, P < 0.001 for all). Increased age was associated with increased event risk and PCI with decreased event risk. CONCLUSIONS Risk of cardiovascular events and mortality after MI increases steeply with age. Although at higher risk, aging patients and those with cardiovascular comorbidities are less likely to receive PCI after MI. Female sex is associated with better survival after MI regardless of less intensive treatment in women.
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Affiliation(s)
- Ville Kytö
- Turku University Hospital and University of Turku, Heart Center, PO Box 52, 20521 Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | | | | | - Pål Hasvold
- AstraZeneca Nordic Baltic, Södertälje, Sweden
| | - Eeva Reissell
- National Institute for Health and Welfare, Helsinki, Finland
| | - Juhani Airaksinen
- Turku University Hospital and University of Turku, Heart Center, PO Box 52, 20521 Turku, Finland
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156
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Long-term outcomes in men and women with ST-segment elevation myocardial infarction and incomplete reperfusion after a primary percutaneous coronary intervention. Coron Artery Dis 2019; 30:171-176. [DOI: 10.1097/mca.0000000000000703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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157
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Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, Lerman A, Cushman M, Kumbhani DJ, Arslanian-Engoren C, Bolger AF, Beltrame JF. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e891-e908. [DOI: 10.1161/cir.0000000000000670] [Citation(s) in RCA: 347] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Myocardial infarction in the absence of obstructive coronary artery disease is found in ≈5% to 6% of all patients with acute infarction who are referred for coronary angiography. There are a variety of causes that can result in this clinical condition. As such, it is important that patients are appropriately diagnosed and an evaluation to uncover the correct cause is performed so that, when possible, specific therapies to treat the underlying cause can be prescribed. This statement provides a formal and updated definition for the broadly labelled term
MINOCA
(incorporating the definition of acute myocardial infarction from the newly released “Fourth Universal Definition of Myocardial Infarction”) and provides a clinically useful framework and algorithms for the diagnostic evaluation and management of patients with myocardial infarction in the absence of obstructive coronary artery disease.
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158
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Hao Y, Liu J, Liu J, Yang N, Smith SC, Huo Y, Fonarow GC, Ge J, Taubert KA, Morgan L, Zhou M, Xing Y, Ma CS, Han Y, Zhao D. Sex Differences in In-Hospital Management and Outcomes of Patients With Acute Coronary Syndrome. Circulation 2019; 139:1776-1785. [PMID: 30667281 DOI: 10.1161/circulationaha.118.037655] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Yongchen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Na Yang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill (S.C.S.)
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China (Y. Huo)
| | - Gregg C Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles (G.C.F.)
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, China (J.G.)
| | - Kathryn A Taubert
- Department of International Science, American Heart Association, Basel, Switzerland (K.A.T.)
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX (L.M.)
| | - Mengge Zhou
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Yueyan Xing
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, China (C.- S.M.)
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Liaoning, China (Y. Han)
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.)
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159
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Marie D, Mingou JS, Dia K, Gbadamassi SEOK, Fall PD, Diao M, Mboup MC. Clinical Presentation, Risk Factor, and Outcomes of Acute Coronary Syndrome in Women at an Urban Referral Center in Dakar, Senegal. Glob Heart 2019; 14:35-39. [PMID: 30905691 DOI: 10.1016/j.gheart.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/03/2018] [Accepted: 01/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease is on the rise in Sub-Saharan countries. Recently, consistent studies have reported sex differences in the epidemiology of acute coronary syndrome (ACS). Although, data on the incidence of ACS in Sub-Saharan countries are not rare, few focused closely on women. OBJECTIVES The purpose of this study was to examine risk factors, clinical presentations, and management strategies in women with ACS. METHODS This was a retrospective study conducted at the Cardiology Department of Principal Hospital of Dakar over a period of 60 months (January 1, 2010, to December 31, 2014), in Dakar, Senegal. Medical records of female subjects admitted for ACS on the basis of anginal pain at rest, suggestive electrocardiographic changes, and elevated troponin I levels were included. We collected and analyzed the epidemiological, clinical, paraclinical, and evolutionary data of the patients. RESULTS Hospital prevalence of ACS in women was 2.32%, meaning 38.1% of patients were admitted for ACS during the same period. The mean age of patients was 68.8 ± 9.5 years; 52% of them were aged between 60 and 69 years. The risk factors in our patients were dominated by hypertension found (63.3%) and diabetes (54.1%). Active smoking was found in 6 patients (6.1%). One-half of patients had more than 1 risk factor. Chest pain was present in 94 patients (95.9%). The average time delay before medical care was administered was 53.9 ± 18 h. Thirty patients showed signs of left ventricular failure (Killip classes I and II). Electrocardiography revealed ACS with persistent ST-segment elevation in 53 patients (54.1%) and non-ST-segment elevation ACS in 45 patients (45.9%). Mean troponin I level was 1.68 ± 2.3 ng/ml. Doppler echocardiography revealed impaired segmental kinetics in more than one-half of patients. The mean ventricular ejection fraction was 43.8 ± 10.1%. Thrombolysis was performed in 10 patients, accounting for 10.2% of patients with ST-segment elevation. The evolution during hospitalization after a mean hospital stay of 9.5 ± 3.7 days was favorable in 66 patients (67.3%). Six deaths (6.1%) were recorded. Complications was dominated by pulmonary edema. CONCLUSIONS Our study confirms that ACS is not a "man's only" disease in Sub-Saharan countries. The major concern is that there appeared to be continuing evidence of suboptimal treatment and intervention in women with ACS in current practice.
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Affiliation(s)
- Djibril Marie
- Department of Cardiology and Internal Medication, Military Hospital of Ouakam, Dakar, Senegal.
| | - Joseph S Mingou
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Khadidiatou Dia
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | | | - Pape D Fall
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Maboury Diao
- Department of Cardiology, University Cheickh Anta Diop, Dakar, Senegal
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160
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Ballesteros-Ortega D, Martínez-González O, Gómez-Casero RB, Quintana-Díaz M, de Miguel-Balsa E, Martín-Parra C, López-Matamala B, Chana-García M, Alonso-Fernández MÁ, Manso-Álvarez M. Characteristics of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) from the ARIAM-SEMICYUC registry: development of a score for predicting MINOCA. Vasc Health Risk Manag 2019; 15:57-67. [PMID: 30936712 PMCID: PMC6422404 DOI: 10.2147/vhrm.s185082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. PATIENTS AND METHODS A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. RESULTS A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer-Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. CONCLUSION Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.
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Affiliation(s)
| | | | | | | | - Eva de Miguel-Balsa
- Critical Care Department, Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain
| | - Carmen Martín-Parra
- Critical Care Department, Hospital Universitario del Tajo, CP 28300, Aranjuez, Spain,
| | - Blanca López-Matamala
- Critical Care Department, Hospital Universitario del Tajo, CP 28300, Aranjuez, Spain,
| | - Miriam Chana-García
- Critical Care Department, Hospital Universitario del Tajo, CP 28300, Aranjuez, Spain,
| | | | - Madián Manso-Álvarez
- Critical Care Department, Hospital Universitario del Tajo, CP 28300, Aranjuez, Spain,
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161
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Anderson RD, Petersen JW, Mehta PK, Wei J, Johnson BD, Handberg EM, Kar S, Samuels B, Azarbal B, Kothawade K, Kelsey SF, Sharaf B, Shaw LJ, Sopko G, Bairey Merz CN, Pepine CJ. Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD). J Interv Cardiol 2019; 2019:7169275. [PMID: 31772544 PMCID: PMC6739787 DOI: 10.1155/2019/7169275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/28/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE In a separate, contemporary cohort, we sought to confirm findings of the original Women's Ischemia Syndrome Evaluation (WISE). BACKGROUND The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. METHODS We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). RESULTS In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. CONCLUSIONS This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.
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Affiliation(s)
| | | | - Puja K. Mehta
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Saibal Kar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bruce Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Babak Azarbal
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kamlesh Kothawade
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Barry Sharaf
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - Leslee J. Shaw
- Cardiovascular Outcomes Research and Epidemiology, Emory University, Atlanta, Georgia, USA
| | - George Sopko
- National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - C. Noel Bairey Merz
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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162
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Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio ALP, De Caterina R, Zimarino M, Roffi M, Kjeldsen K, Atar D, Kaski JC, Sechtem U, Tornvall P. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2019; 38:143-153. [PMID: 28158518 DOI: 10.1093/eurheartj/ehw149] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - John F Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Adelaide, Australia
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Wien, Austria
| | - Giuseppe Rosano
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.,Abteilung für Kardiologie, Robert-Bosch Krankenhaus Stuttgart, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Alida L P Caforio
- Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences Padua University Medical School, Policlinico Universitario, Via N Giustiniani, 2, 35128 Padova, Italy
| | | | - Marco Zimarino
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy
| | - Marco Roffi
- Division of Cardiology, University Hospital, 1211 Geneva 14, Switzerland
| | - Keld Kjeldsen
- Copenhagen University Hospitals (Rigshospitalet and Holbæk Hospital), Copenhagen and Holbæk, and The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Atar
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Juan C Kaski
- Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Udo Sechtem
- Abteilung für Kardiologie, Robert-Bosch Krankenhaus Stuttgart, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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163
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Modifiable Risk Factors in Young Adults With First Myocardial Infarction. J Am Coll Cardiol 2019; 73:573-584. [PMID: 30732711 DOI: 10.1016/j.jacc.2018.10.084] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
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164
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Abstract
There are important sex-related differences in elderly patients with acute coronary syndrome (ACS). Women are older, more frequently frail, and present more comorbidities than men. Atypical symptoms at presentation are also more common in female patients, they are leaded to a delayed diagnosis and treatment. Coronary angiography and subsequent revascularization are frequently underused in elderly women and they tend to receive less guidelines-recommended therapies. The prognosis in elderly frail women with ACS is poor, and it is with high mortality and readmissions rates. Bleeding is recurrent ischemic events in which it is more frequent in women than in men. Recovery time might be long, and a multidisciplinary approach is desirable to improve prognosis and quality of life. Further studies are needed in order to clarify the benefit of the different therapies in the group of frail women, and this is particularly true for revascularization, as scientific evidence in this group is very scarce.
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165
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Taqueti VR. Novel Imaging Approaches for the Diagnosis of Stable Ischemic Heart Disease in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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166
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Clerc Liaudat C, Vaucher P, De Francesco T, Jaunin-Stalder N, Herzig L, Verdon F, Favrat B, Locatelli I, Clair C. Sex/gender bias in the management of chest pain in ambulatory care. ACTA ACUST UNITED AC 2019; 14:1745506518805641. [PMID: 30370833 PMCID: PMC6300868 DOI: 10.1177/1745506518805641] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care. Setting: We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland. Participants: In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women. Main outcome measures: The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months. Results: The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs 14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women (16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52–4.09). After adjustment for the patients’ age and cardiovascular disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30–3.78). Conclusion: Although the same proportion of women and men present with a chest pain of cardiovascular origin in ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure equity between men and women in medical care.
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Affiliation(s)
- Christelle Clerc Liaudat
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Paul Vaucher
- 2 Unit of Traffic Medicine and Psychology, University Centre of Legal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,3 School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Tommaso De Francesco
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicole Jaunin-Stalder
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.,4 Cabinet Médical de Cugy, Cugy, Switzerland
| | - Lilli Herzig
- 5 Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - François Verdon
- 5 Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bernard Favrat
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- 1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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167
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Alsawas M, Wang Z, Murad MH, Yousufuddin M. Gender disparities among hospitalised patients with acute myocardial infarction, acute decompensated heart failure or pneumonia: retrospective cohort study. BMJ Open 2019; 9:e022782. [PMID: 30670508 PMCID: PMC6347873 DOI: 10.1136/bmjopen-2018-022782] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess gender disparity in outcomes among hospitalised patients with acute myocardial infarction (AMI), acute decompensated heart failure (ADHF) or pneumonia. DESIGN A retrospective cohort study. SETTING A tertiary referral centre in Midwest, USA. PARTICIPANTS We evaluated 12 265 adult patients hospitalised with ADHF, 15 777 with AMI and 12 929 with pneumonia, from 1 January 1995 through 31 August 2015. Patients were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of comorbidities, 30-day mortality and 30-day readmission. Comorbidities were chosen from the 20 chronic conditions, specified by the Office of the Assistant Secretary for Health. Logistic regression analysis was conducted adjusting for multiple confounders. RESULTS Prevalence of comorbidities was significantly different between men and women in all three conditions. After adjusting for age, length of stay, multicomorbidities and residence, there was no significant difference in 30-day mortality between men and women in AMI or ADHF, but men with pneumonia had slightly higher 30-day mortality with an OR of 1.19 (95% CI 1.06 to 1.34). There was no significant difference in 30-day readmission between men and women with AMI or pneumonia, but women with ADHF were slightly more likely to be readmitted within 30 days with OR 0.90 (95% CI 0.82 to 0.99). CONCLUSION Gender differences in the distribution of comorbidities exist in patients hospitalised with AMI, ADHF and pneumonia. However, there is minimal clinically meaningful impact of these differences on outcomes. Efforts to address gender difference may need to be diverted towards targeting overall population health, reducing race/ethnicity disparity and improving access to care.
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Affiliation(s)
- Mouaz Alsawas
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Robert D and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
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168
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Gul I, Cerit L, Senturk B, Alkan MB, Kemal H, Cerit Z, Yaman B, Usalp S, Duygu H. The Importance of Intra-aortic Pulse Pressure After Anterior ST-segment Elevation Myocardial Infarction. Braz J Cardiovasc Surg 2019; 33:579-587. [PMID: 30652747 PMCID: PMC6326447 DOI: 10.21470/1678-9741-2018-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the association of pulse pressure (PP) with mortality and major
adverse cardiac events (MACE) in one-year period after anterior ST-elevation
myocardial infarction (A-STEMI). Methods A total of 261 consecutive patients whose blood pressure was measured with
the aid of a catheter before primary percutaneous coronary intervention
(PPCI) between August 2016 and February 2017 were included in the study. The
patients were divided into three groups according to pulse pressure (PP)
(Group 1, PP<35 mmHg; Group 2, 35≤PP≤50 mmHg; Group 3,
PP>50 mmHg). Results The mean age of the patients was 63.4±14.1 years, and 206 of them were
male. The groups were similar in terms of age and diastolic blood pressure
(DBP). The ratio of female patients in Group 1 was higher, and their
systolic blood pressure (SBP) was lower than those from the other groups
(P=0.005 vs.
P=0.042). The rates of MACE and mortality were higher in
Group 1. The predictive PP values were calculated to be 42.5 mmHg for
development of MACE and 41.5 mmHg for mortality. One-year survival ratio was
worse in Group 1 than in the others according to Kaplan-Meier analysis
(P<0.001). Conclusion The values of PP which was measured intra-aortically in patients with A-STEMI
were associated with mortality and MACE in the one-year follow-up
period.
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Affiliation(s)
- Ilker Gul
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Levent Cerit
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Bihter Senturk
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | | | - Hatice Kemal
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Zeynep Cerit
- Department of Pediatric Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Belma Yaman
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Songul Usalp
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Hamza Duygu
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
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169
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Kanic V, Kompara G, Vollrath M, Suran D, Kanic Z. Age-Specific Sex-Based Differences in Anemia in Patients with Myocardial Infarction. J Womens Health (Larchmt) 2019; 28:1004-1010. [PMID: 30632879 DOI: 10.1089/jwh.2018.7211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Data are lacking concerning possible age-specific sex-based differences in anemia in myocardial infarction (MI) patients and its association with the outcome. The aim was to assess whether these differences in anemia (on admission and at discharge) in MI patients who underwent percutaneous coronary intervention (PCI) are associated with the outcome. Methods: Data from 5579 MI patients (31.0% women) undergoing PCI at our institution were analyzed. Men and women in different age groups were compared regarding anemia and its association with the 30-day and long-term all-cause mortality. Data were analyzed using descriptive statistics. Results: Women suffered anemia more than men (37.5% vs. 26.8%; p < 0.0001). The prevalence of anemia increased rapidly with age in men but not in women. A J-shaped relationship between age and anemia was found in women. The lower the age, the greater the difference in the prevalence of anemia between the sexes. The difference in the prevalence of anemia at discharge was even more pronounced. Anemia on admission (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.10-1.76; p = 0.005) and at discharge (OR = 2.61; 95% CI = 1.98-3.44; p < 0.0001) predicted a higher 30-day mortality. Women had a better adjusted long-term prognosis (hazard ratio [HR] = 0.78; 95% CI = 0.69-0.87; p < 0.0001) for the total population. Anemia on admission (HR = 1.43; 95% CI = 1.29-1.60; p < 0.0001) and at discharge (HR = 1.96; 95% CI = 1.23-2.21; p < 0.0001) predicted a higher long-term mortality. Conclusion: Younger women with MI suffer anemia more frequently than their male peers. Anemia was associated with a worse outcome. Age-specific sex-based differences in anemia help to explain the increased sex-related mortality in MI patients undergoing PCI.
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Affiliation(s)
- Vojko Kanic
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Gregor Kompara
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | | | - David Suran
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Zlatka Kanic
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
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170
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Bugiardini R, Manfrini O, Cenko E. Female sex as a biological variable: A review on younger patients with acute coronary syndrome. Trends Cardiovasc Med 2019; 29:50-55. [DOI: 10.1016/j.tcm.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
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171
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Leutner M, Tscharre M, Farhan S, Taghizadeh Waghefi H, Harreiter J, Vogel B, Tentzeris I, Szekeres T, Fritzer-Szekeres M, Huber K, Kautzky-Willer A. A Sex-Specific Analysis of the Predictive Value of Troponin I and T in Patients With and Without Diabetes Mellitus After Successful Coronary Intervention. Front Endocrinol (Lausanne) 2019; 10:105. [PMID: 30881344 PMCID: PMC6405417 DOI: 10.3389/fendo.2019.00105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Elevated levels of troponin are associated with future major adverse cardiac events (MACE). Data on the prognostic value of high sensitive troponin T (hs-TnT) compared to high sensitive troponin I (hs-TnI) in diabetic and non-diabetic patients are sparse. Methods: We analyzed patients of a single-center registry undergoing coronary stenting between 2003 and 2006. As a primary endpoint we assessed MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke according to sex and diabetes status using log-rank. As a second endpoint, we assessed the prognostic impact of hs-TnT and hs-TnI on MACE, adjusting for known confounders using Cox regression analysis. Results: Out of 818 investigated patients, 267 (32.6%) were female. Diabetes mellitus type 2 (T2DM) was diagnosed in 206 (25.2%) patients. After a mean follow-up of 6.6 ± 3.7 years, MACE occurred in 235 (28.7%) patients. The primary endpoint components of cardiovascular death occurred in 115 (14.1%) patients, MI in 75 (9.2%), and ischemic stroke in 45 (5.5%). Outcomes differed significantly according to sex and diabetes status (p = 0.003). In descending order, MACE rates were as follows: female diabetic patients (40.8%), female non-diabetic patients (32.7%), male diabetic patients (28.9%), and male non-diabetic patients (24.8%). Additionally, females with diabetes were at higher risk of cardiovascular death compared to diabetic men (28 vs. 15%). Hs-TnI (HR 1.477 [95% CI 1.100-1.985]; p = 0.010) and hs-TnT (HR 1.615 [95%CI 1.111-2.348]; p = 0.012) above the 99th percentile were significantly associated with MACE. Both assays showed tendency toward association with MACE in all subgroups. Conclusion: Diabetic patients, particularly females, with known coronary artery disease had a higher risk of subsequent MACE. Both, hs-TnI and hs-TnT significantly correlated with MACE.
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Maximilian Tscharre
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
- Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Poelten, Austria
| | - Serdar Farhan
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, United States
| | - Hossein Taghizadeh Waghefi
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Vogel
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Ioannis Tentzeris
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Thomas Szekeres
- Department of Medical-Chemical Laboratory Analysis, Medical University of Vienna, Vienna, Austria
| | - Monika Fritzer-Szekeres
- Department of Medical-Chemical Laboratory Analysis, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria
- *Correspondence: Alexandra Kautzky-Willer
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172
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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173
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Li T, Wang F, Peng R, Pei S, Hou Z, Lu B, Cong X, Chen X. Sex-related differences in the association between plasma fibrinogen and non-calcified or mixed coronary atherosclerotic plaques. Biol Sex Differ 2018; 9:51. [PMID: 30518417 PMCID: PMC6282270 DOI: 10.1186/s13293-018-0210-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/22/2018] [Indexed: 12/19/2022] Open
Abstract
Background Plasma fibrinogen (FIB) has been demonstrated to be a risk factor for cardiovascular disease. Patients with non-calcified plaque (NCP) or mix plaque (MP) have a higher risk of poor outcomes. However, the association between FIB and the presence of NCP or MP (NCP/MP) remains unclear, and if present, whether sex has any impact on this association remains unknown. The aim of this study was to investigate the role of FIB in predicting the presence of NCP/MP and evaluate whether sex has any impact on this association. Methods A total of 329 subjects were recruited, and the clinical and laboratory data were collected. Plasma FIB was detected by enzyme-linked immunosorbent assay. According to whether they had coronary atherosclerotic plaques and the characteristics of the most stenotic plaque, we divided them into three groups: no plaque (NP), calcified plaque (CP), and NCP/MP. Results Patients with NCP/MP had significantly higher FIB level in females, but not in males. Multiple logistic regression analysis showed that FIB was an independent risk factor for the presence of NCP/MP (odds ratio [OR] = 3.677, 95% CI 1.539–8.785, P = 0.003) in females. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value FIB for predicting the presence of NCP/MP was 3.41 g/L (area under curve [AUC] = 0.73, 95% CI 0.63–0.82, P < 0.001) in females. Conclusions FIB is independently associated with the presence of NCP/MP in females, but not in males. These results suggest that the potential significance of FIB-lowering regimens in females with NCP/MP.
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Affiliation(s)
- Tiewei Li
- Department of Clinical Laboratory Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Street, Xi-Cheng District, Beijing, 100037, China
| | - Fang Wang
- Department of Clinical Laboratory Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Street, Xi-Cheng District, Beijing, 100037, China.
| | - Rui Peng
- Department of Clinical Laboratory Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Street, Xi-Cheng District, Beijing, 100037, China
| | - Shengqiang Pei
- Department of Clinical Laboratory Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Street, Xi-Cheng District, Beijing, 100037, China
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiangfeng Cong
- Department of Clinical Laboratory Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Street, Xi-Cheng District, Beijing, 100037, China
| | - Xi Chen
- Department of Clinical Laboratory Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Street, Xi-Cheng District, Beijing, 100037, China.
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174
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Adegoke O, Awolola NA, Ajuluchukwu JN. Prevalence and pattern of cardiovascular-related causes of out-of- hospital deaths in Lagos, Nigeria. Afr Health Sci 2018; 18:942-949. [PMID: 30766558 PMCID: PMC6354864 DOI: 10.4314/ahs.v18i4.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background In developed countries 50% – 75% of deaths from cardiovascular-diseases occurs out-of-hospital. In Nigeria where patronage of orthodox health facilities is low, the impact of cardiovascular-related diseases on out-of-hospital mortality has been sparsely studied. Objectives To determine the prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria. Methods A 5-year retrospective review of all autopsied medical decedents brought-in-dead (BID) to a Nigerian tertiary health facility to identify cardiovascular-related causes of death. Results A total of 90 cardiovascular-related deaths out of 176 medical BID cases were identified, giving a prevalence of 51.1%. Mean age was 65.2 ± 15.6 years. Male: Female ratio was 1.4: 1, the females were older (68.29 ± 14.89) vs (61.63 ± 15.55) years. Age group > 60 years accounted for 63.3% of deaths. Commonest primary diseases were hypertensive heart disease (48.9%) and cerebrovascular accident (24.4%). Myocardial infarction occurred in 8.9%. Heart failure, cerebral dysfunction and unspecified circulatory collapse were the causes of death in 54.4%, 23.3% and 14.4% respectively. Conclusion Cardiovascular-related diseases are major contributors to out-of-hospital medical deaths occurring chiefly in those >60 years. Hypertensive heart disease and heart failure are the greatest contributors to this cardiovascular-related disease mortality.
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Affiliation(s)
- Oluseyi Adegoke
- College of Medicine, University of Lagos, Nigeria, Department of Medicine
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175
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Carvalho JF, Belo A, Congo K, Neves D, Santos AR, Piçarra B, Damásio AF, Aguiar J. Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence, clinical outcomes and predictors. Rev Port Cardiol 2018; 37:911-919. [PMID: 30449610 DOI: 10.1016/j.repc.2018.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/19/2018] [Accepted: 03/11/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A low-risk GRACE score identifies patients with a lower incidence of major cardiac events, however it can erroneously classify patients with severe coronary artery disease as low-risk. We assessed the prevalence, clinical outcomes and predictors of left main and/or three-vessel disease (LM/3VD) in non-ST-elevation acute myocardial infarction (NSTEMI) patients with a GRACE score of ≤108 at admission. METHODS Using data from the Portuguese Registry on Acute Coronary Syndromes, 1196 patients with NSTEMI and a GRACE score of ≤108 who underwent coronary angiography were studied. Independent predictors of LM/3VD and its impact on in-hospital complications and one-year mortality were retrospectively analyzed. RESULTS LM/3VD was present in 18.2% of patients. Its prevalence was higher in males and associated with hypertension, diabetes, previous myocardial infarction, heart failure and peripheral arterial disease (PAD). Although there were no differences in in-hospital complications, these patients had higher mortality (0.9 vs. 0.0%) and more major adverse cardiac and cerebrovascular events (MACCE) (4.1 vs. 2.5%, p=0.172), and higher one-year mortality (2.4 vs. 0.5%, p=0.005). Independent predictors of LM/3VD were age (OR 1.03; 95% CI 1.01-1.0, p=0.003), male gender (OR 2.56; 95% CI 1.56-4.17, p<0.001), heart rate (1.02; 95% CI 1.01-1.03, p<0.001), PAD (OR 3.21; 95% CI 1.47-7.00, p<0.001) and heart failure (OR 3.38; 95% CI 1.02-11.15, p=0.046). CONCLUSIONS LM/3VD was found in one in five patients. These patients had a tendency for higher in-hospital mortality and more MACCE, and higher one-year mortality. Simple clinical variables could help predict this severe coronary anatomy.
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Affiliation(s)
| | - Adriana Belo
- Biostatistics Department, Portuguese Society of Cardiology, Lisbon, Portugal
| | - Kisa Congo
- Cardiology Department, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - David Neves
- Cardiology Department, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Ana Rita Santos
- Cardiology Department, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Bruno Piçarra
- Cardiology Department, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Ana Filipa Damásio
- Cardiology Department, Hospital Distrital de Santarém, Santarém, Portugal
| | - José Aguiar
- Cardiology Department, Hospital do Espírito Santo de Évora, Évora, Portugal
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176
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Carvalho JF, Belo A, Congo K, Neves D, Santos AR, Piçarra B, Damásio AF, Aguiar J. Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence, clinical outcomes and predictors. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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177
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Hausvater A, Reynolds HR. Troponin Testing in the Emergency Room: Closing the Gap on Diagnostic Delays in Young Female Patients with Cardiac Chest Pain. J Womens Health (Larchmt) 2018; 27:1305-1306. [PMID: 30256703 DOI: 10.1089/jwh.2018.7359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anais Hausvater
- Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine , New York, New York
| | - Harmony R Reynolds
- Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine , New York, New York
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178
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Lam L, Ahn HJ, Okajima K, Schoenman K, Seto TB, Shohet RV, Miyamura J, Sentell TL, Nakagawa K. Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome. Womens Health Issues 2018; 29:17-22. [PMID: 30482594 DOI: 10.1016/j.whi.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/27/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been reported that women have higher 30-day readmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied. METHODS Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate. RESULTS A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09-1.60), Medicaid (OR, 1.48; 95% CI, 1.07-2.06), Medicare (1.72; 95% CI, 1.35-2.19), heart failure (1.88; 95% CI, 1.53-2.33), atrial fibrillation (OR, 1.54; 95% CI-1.21-1.95), substance use (OR, 1.88; 95% CI, 1.27-2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29-4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42-2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS. CONCLUSIONS Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS.
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Affiliation(s)
- Luke Lam
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
| | - Hyeong Jun Ahn
- Department of Complementary and Integrative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Kazue Okajima
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Katie Schoenman
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Todd B Seto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; The Queen's Medical Center, Honolulu, Hawaii
| | - Ralph V Shohet
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jill Miyamura
- Hawaii Health Information Corporation, Honolulu, Hawaii
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawaii, Honolulu, Hawaii
| | - Kazuma Nakagawa
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; The Queen's Medical Center, Honolulu, Hawaii
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Fu WX, Zhou TN, Wang XZ, Zhang L, Jing QM, Han YL. 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. Chin Med J (Engl) 2018; 131:1420-1429. [PMID: 29893358 PMCID: PMC6006816 DOI: 10.4103/0366-6999.233965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Females with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEMI is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI after percutaneous coronary intervention (PCI) in China. This study sought to analyze the sex differences in 30-day, 1-year, and long-term net adverse clinical events (NACEs) in Chinese adult patients with STEMI after PCI. Methods: This study retrospectively analyzed 1920 consecutive STEMI patients (age ≤60 years) treated with PCI from January 01, 2006, to December 31, 2012. A propensity score analysis between males and females was performed to adjust for differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was performed using a Cox proportional hazards model for 3-year NACE. Results: Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class (≥3), with more multivessel diseases (P < 0.05). The female group had a higher levels of low-density lipoprotein (2.72 [2.27, 3.29] vs. 2.53 [2.12, 3.00], P < 0.001), high-density lipoprotein (1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P = 0.003), total cholesterol (4.98 ± 1.10 vs. 4.70 ± 1.15, t = −3.508, P < 0.001), and estimated glomerular filtration rate (103.12 ± 22.22 vs. 87.55 ± 18.03, t = −11.834, P < 0.001) than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared with males. In the multivariate model, female gender (hazard ratio [HR]: 2.557, 95% confidence interval [CI]: 1.415–4.620, P = 0.002), hypertension (HR: 2.017, 95% CI: 1.138–3.576, P = 0.016), and family history of coronary heart disease (HR: 2.256, 95% CI: 1.115–4.566, P = 0.024) were independent risk factors for NACE. The number of stents (HR: 0.625, 95% CI: 0.437–0.894, P = 0.010) was independent protective factors of NACE. Conclusions: Females with STEMI undergoing PCI have a significantly higher risk for 3-year NACE compared with males in this population. Sex differences appear to be a risk factor and present diagnostic challenges for clinicians.
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Affiliation(s)
- Wen-Xia Fu
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Tie-Nan Zhou
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Xiao-Zeng Wang
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Lei Zhang
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Quan-Min Jing
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Ya-Ling Han
- Department of Cardiology, The General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
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180
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Chou LP, Zhao P, Kao C, Chen YH, Jong GP. Women were noninferior to men in cardiovascular outcomes among patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention from Taiwan acute coronary syndrome full-spectrum registry. Medicine (Baltimore) 2018; 97:e12998. [PMID: 30412135 PMCID: PMC6221713 DOI: 10.1097/md.0000000000012998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study was conducted to compare the survival rate and the influencing factors between women and men following ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).A national-wide Acute Coronary Syndrome Full Spectrum Registry conducted by the Taiwan Society of Cardiology was used for data collection between October 2008 and January 2010. Details of 1621 patients with STEMI treated with primary PCI, including 1350 (83%) men and 271 (17%) women, were collected. Composite outcomes included all-cause death, myocardial reinfarction, and an ischemic stroke. Demographic data, comorbidities, clinical presentations, details of treatment received, and outcomes were recorded at 3-month intervals for 1 year.No significant difference was observed between men and women in the composite endpoints after STEMI during their hospital stay (5.5% vs 2.5%, P = .07). However, women showed significantly higher in-hospital and 1-year mortality rates than those of men (4.1% vs 1.8%, P = .008; 11.0% vs 4.1%, P = .000, respectively). Compared with men, women presented with higher age (mean age 68.9 vs 58.9 years, P = .001), less body weight (58.7 vs 70.9 kg, P < .001), more number of risk factors, delayed diagnosis, and more number of inadequate medical treatments. After adjusting for age and cardiovascular risk factors, the difference in mortality ceased to exist between men and women.Although female patients with STEMI-treated primary PCI had higher in-hospital and 1-year mortality rates than those of males in Taiwan, there was no gender difference after adjusting for age and cardiovascular risk factors.
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Affiliation(s)
- Li-Ping Chou
- Division of Internal Cardiology, Department of Medicine, Sin-Lau Hospital
- Department of Health Care Administration, Chang Jung Christian University, Tainan
| | - Ping Zhao
- Department of Ultrasound, Shangluo Central Hospital, Shangluo, Shaanxi Province
| | - Chieh Kao
- Division of Internal Cardiology, Department of Medicine, Sin-Lau Hospital, Tainan
| | - Yen-Hsun Chen
- Division of Internal Cardiology, Department of Medicine, Sin-Lau Hospital, Tainan
| | - Gwo-Ping Jong
- Division of Internal Cardiology, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, ROC
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181
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You B, Zhu B, Su X, Liu F, Wang B. Gender Differences among Elderly Patients with Primary Percutaneous Coronary Intervention. Aging Dis 2018; 9:852-860. [PMID: 30271662 PMCID: PMC6147591 DOI: 10.14336/ad.2017.1129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022] Open
Abstract
Several epidemiological and clinical studies have shown that females with ST-segment elevation myocardial infarction (STEMI) have a higher mortality than males following primary percutaneous coronary intervention (PPCI). Many analyses of sex-based differences following STEMI have revealed conflicting results. Currently, more and more elderly patients with STEMI have undergone emergency interventional therapy. From January 2014 to December 2016, a total of 337 elderly patients with STEMI were enrolled in this study from two chest pain centers, and all patients underwent PPCI. Patients were divided into two groups: elderly females (n=117, mean age 73.4±9.6 years) and elderly males (n=220, mean age 71.7±8.6 years). The prevalence of diabetes was higher in females than in males (29.1% vs. 19.6%,P<0. 01). Typical ischemic chest pain was lower in females than in males (45.3% vs 57.3%, P<0.01). The number of nonsmokers was also significantly higher in females than in males (5.1% vs. 52.3%,P<0. 01). Serum creatinine (sCr) levels (87.6±17.4 umol/L vs 99.5±20.2 umol/L,P<0.01) and body mass index (23.8±2.7 vs 27.3±3.1, P<0.01) were lower in females than in males. The incidences of major adverse cardiac events (MACE) in-hospital showed no significantly difference (P>0.05) between the two groups. However, the cumulative MACE showed a significant difference between the two groups in the 12-month follow-up (16.8% in male vs 12.8% in female, P = 0.04). Our results suggest that the PPCI is safe and effective in elderly female STEMI patients. The cumulative MACE in females are not higher than in males. PPCI are helpful in elderly STEMI patients.
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Affiliation(s)
- Binquan You
- Departments of Cardiology, Suzhou Kowloon Hospital, School of Medicine Shanghai Jiaotong University, Suzhou, 215000, China
| | - Bingbing Zhu
- Departments of Cardiology, Suzhou Kowloon Hospital, School of Medicine Shanghai Jiaotong University, Suzhou, 215000, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, 430000, China
| | - Feng Liu
- Departments of Cardiology, Suzhou Kowloon Hospital, School of Medicine Shanghai Jiaotong University, Suzhou, 215000, China
| | - Bingyin Wang
- Departments of Cardiology, Suzhou Kowloon Hospital, School of Medicine Shanghai Jiaotong University, Suzhou, 215000, China
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182
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Khan E, Brieger D, Amerena J, Atherton JJ, Chew DP, Farshid A, Ilton M, Juergens CP, Kangaharan N, Rajaratnam R, Sweeny A, Walters DL, Chow CK. Differences in management and outcomes for men and women with ST‐elevation myocardial infarction. Med J Aust 2018; 209:118-123. [DOI: 10.5694/mja17.01109] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | | | - Derek P Chew
- Flinders Medical Centre, Adelaide, SA
- Flinders University, Adelaide, SA
| | | | | | | | | | | | - Amy Sweeny
- Gold Coast University Hospital, Gold Coast, QLD
| | | | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW
- Westmead Hospital, Sydney, NSW
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183
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Höhn A, Larsen LA, Schneider DC, Lindahl-Jacobsen R, Rau R, Christensen K, Oksuzyan A. Sex differences in the 1-year risk of dying following all-cause and cause-specific hospital admission after age 50 in comparison with a general and non-hospitalised population: a register-based cohort study of the Danish population. BMJ Open 2018; 8:e021813. [PMID: 30018099 PMCID: PMC6059308 DOI: 10.1136/bmjopen-2018-021813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/03/2018] [Accepted: 06/07/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We examine the mortality of men and women within the first year after all-cause and cause-specific hospital admission to investigate whether the sex differences in mortality after hospitalisation are higher than in the corresponding general and non-hospitalised population. DESIGN This is a population-based, longitudinal study with nationwide coverage. The study population was identified by linking the National Patient Register with the Central Population Register using a 5% random sample of the Danish population. SETTING The population born between 1898 and 1961, who was alive and residing in Denmark after 1977, was followed up between 1977 and 2011 with respect to hospital admissions and mortality while aged 50-79. PRIMARY OUTCOME MEASURES The absolute sex differences in the 1-year risk of dying after all-cause and cause-specific hospital admission. The hospitalised population sex differentials were then compared with the sex differences in a general and a non-hospitalised population, randomly matched by age, sex and hospitalisation status. RESULTS The risk of dying was consistently higher for hospitalised men and women. At all ages, the absolute sex differences in mortality were largest in the hospitalised population, were smaller in the general population and were smallest in the non-hospitalised population. This pattern was consistent across all-cause admissions, and with respect to admissions for neoplasms, circulatory diseases and respiratory diseases. For all-cause hospital admissions, absolute sex differences in the 1-year risk of dying resulted in 43.8 excess male deaths per 1,000 individuals within the age range 50-79, while the levels were lower in the general and the non-hospitalised population, at levels of 13.5 and 6.6, respectively. CONCLUSIONS This study indicates a larger male disadvantage in mortality following hospitalisation, pointing towards an association between the health status of a population and the magnitude of the female advantage in mortality.
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Affiliation(s)
- Andreas Höhn
- Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Aagaard Larsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark
| | | | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Roland Rau
- Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Sociology and Demography, University of Rostock, Rostock, Germany
| | - Kaare Christensen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark
- Danish Aging Research Center, Odense, Denmark
| | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany
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184
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Bataille Y, Costerousse O, Bertrand OF, Moranne O, Pottel H, Delanaye P. One-year mortality of patients with ST-Elevation myocardial infarction: Prognostic impact of creatinine-based equations to estimate glomerular filtration rate. PLoS One 2018; 13:e0199773. [PMID: 29979700 PMCID: PMC6034802 DOI: 10.1371/journal.pone.0199773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Renal dysfunction is associated with worse outcomes after primary percutaneous coronary intervention (PCI). However, whether glomerular filtration rate (GFR) estimated with various equations can equally predict outcomes after ST-Elevation Myocardial Infarction (STEMI) is still debated. METHODS We compared the clinical impact of 3 different creatinine-based equations (Cockcroft and Gault (CG), CKD-epidemiology (CKD-EPI) and Full Age Spectrum (FAS)) to predict 1-year mortality in STEMI patients. RESULTS Among 1755 consecutive STEMI patients who had undergone primary PCI included between 2006 and 2011, median estimated GFR was 79 (61;96) with the CG, 81 (65;95) with CKD-EPI and 75 (60;91) mL/min/1.73 m2 with FAS equation. Reduced GFR values were independently associated with 1-year mortality risk with the 3 equations. Receiver operating curves (ROC) of CG and FAS equations were significantly superior to the CKD-EPI equation, p = 0.03 and p = 0.01, respectively. Better prediction with FAS and CG equations was confirmed by net reclassification index. CONCLUSIONS Our results suggest that in STEMI patients who have undergone primary PCI, 1-year mortality is better predicted by CG or FAS equations compared to CKD-EPI.
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Affiliation(s)
- Yoann Bataille
- Quebec Heart-Lung Institute, Quebec, Canada
- Department of Cardiology, Centre Hospitalier Régional la Citadelle, Liège, Belgium
| | | | | | - Olivier Moranne
- Department of Nephrology-Dialysis-Apheresis, CHU de Nîmes, Medical School, University Montpellier-Nimes, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, Kulak, University of Leuven, Kortrijk, Belgium
| | - Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (CHU ULg), Liège, Belgium
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185
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Quality of Care and 30-day Mortality of Women and Men With Acute Myocardial Infarction. ACTA ACUST UNITED AC 2018; 72:543-552. [PMID: 29980406 DOI: 10.1016/j.rec.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/04/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Despite increased awareness of sex disparities in care and outcomes of acute myocardial infarction (AMI), there appears to have been no consistent attenuation of these differences over the last decade. We investigated differences by sex in management and 30-day mortality using the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QIs) for AMI. METHODS Proportions and standard errors of the 20 Acute Cardiovascular Care Association QIs were calculated for 771 patients with AMI who were admitted to the cardiology departments of 2 tertiary hospitals in Portugal between August 2013 and December 2014. The association between the composite QI and 30-day mortality was derived from logistic regression. RESULTS Significantly fewer eligible women than men received timely reperfusion, were discharged on dual antiplatelet therapy and high-intensity statins, and were referred to cardiac rehabilitation. Women were less likely to receive recommended interventions (59.6% vs 65.2%; P <.001) and also had higher mean GRACE 2.0 risk score-adjusted 30-day mortality (3.0% vs 1.7%; P <.001). An inverse association between the composite QI and crude 30-day mortality was observed for both sexes (OR, 0.08; 95%CI, 0.01-0.64 for the highest performance tertile vs the lowest). CONCLUSIONS Performance in AMI management is worse for women than men and is associated with higher 30-day mortality, which is also worse for women. Evidence-based QIs have the potential to improve health care delivery and patient prognosis in the overall AMI population and may also bridge the disparity gap between women and men.
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186
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Claessen BE, Henriques JPS. Patient delay in women with STEMI: Time to raise awareness. Int J Cardiol 2018; 262:30-31. [PMID: 29706392 DOI: 10.1016/j.ijcard.2018.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Bimmer E Claessen
- Academic Medical Center - University of Amsterdam, department of cardiology, Amsterdam, The Netherlands
| | - José P S Henriques
- Academic Medical Center - University of Amsterdam, department of cardiology, Amsterdam, The Netherlands.
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187
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Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep 2018; 20:64. [DOI: 10.1007/s11886-018-1006-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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188
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Kanic V, Kompara G, Vollrath M, Suran D, Kanic Z. Sex-Related Anemia Contributes to Disparities in Outcome of Patients Younger Than 60 Years with ST-Elevation Myocardial Infarction. J Womens Health (Larchmt) 2018; 27:755-760. [DOI: 10.1089/jwh.2017.6644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Vojko Kanic
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Gregor Kompara
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | | | - David Suran
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Zlatka Kanic
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
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189
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Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G, Kalpak O, Ricci B, Milicic D, Manfrini O, van der Schaar M, Badimon L, Bugiardini R. Sex Differences in Outcomes After STEMI: Effect Modification by Treatment Strategy and Age. JAMA Intern Med 2018; 178:632-639. [PMID: 29630703 PMCID: PMC6145795 DOI: 10.1001/jamainternmed.2018.0514] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Previous works have shown that women hospitalized with ST-segment elevation myocardial infarction (STEMI) have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI). OBJECTIVE To investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications, and primary PCI in this excess of risk. DESIGN, SETTING, AND PARTICIPANTS From January 2010 to January 2016, a total of 8834 patients were hospitalized and received medical treatment for STEMI in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776). EXPOSURES Demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI. MAIN OUTCOMES AND MEASURES Adjusted 30-day mortality rates estimated using inverse probability of treatment weighted (IPTW) logistic regression models. RESULTS There were 2657 women with a mean (SD) age of 66.1 (11.6) years and 6177 men with a mean (SD) age of 59.9 (11.7) years included in the study. Thirty-day mortality was significantly higher for women than for men (11.6% vs 6.0%, P < .001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% vs 3.3%, P < .001). After multivariable adjustment for comorbidities and treatment covariates, women under 60 had higher early mortality risk than men of the same age category (OR, 1.88; 95% CI, 1.04-3.26; P = .02). The risk in the subgroups aged 60 to 74 years and over 75 years was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P = .19 and OR, 1.17; 95% CI, 0.80-1.73; P = .40; respectively). After IPTW adjustment for baseline clinical covariates, the relationship among sex, age category, and 30-day mortality was similar (OR, 1.56 [95% CI, 1.05-2.3]; OR, 1.49 [95% CI, 1.15-1.92]; and OR, 1.21 [95% CI, 0.93-1.57]; respectively). CONCLUSIONS AND RELEVANCE Younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities. This difference declines after age 60 and is no longer observed in oldest women.
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Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Jinsung Yoon
- Department of Electrical and Computer Engineering, University of California, Los Angeles
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | - Goran Stankovic
- Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | - Gordana Krljanac
- Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Oliver Kalpak
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Mihaela van der Schaar
- Department of Electrical and Computer Engineering, University of California, Los Angeles
| | - Lina Badimon
- Cardiovascular Research Institute (ICCC), CiberCV-Institute Carlos III, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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190
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Bainey KR, Welsh RC, Alemayehu W, Westerhout CM, Traboulsi D, Anderson T, Brass N, Armstrong PW, Kaul P. Population-level incidence and outcomes of myocardial infarction with non-obstructive coronary arteries (MINOCA): Insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study. Int J Cardiol 2018; 264:12-17. [PMID: 29655952 DOI: 10.1016/j.ijcard.2018.04.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a known clinical conundrum with limited investigation. Using a large population-based cohort, we examined the incidence, demographic profile, use of evidence-based medicines (EBM) and clinical outcomes of MINOCA patients. METHODS Patients hospitalized with a primary diagnosis of MI who underwent coronary angiography between 01/04/2002 and 31/03/2014 in Alberta, Canada, were included in the study. Comparisons were made between patients with MINOCA versus obstructive coronary disease (OCD). The primary composite endpoint was 1-year all-cause death or re-MI. RESULTS Of 35,928 patients hospitalized with MI, 2092 (5.8%) had MINOCA. In-hospital mortality rate was 0.8% among MINOCA, and 2.7% among patients with OCD (p < 0.0001). At 6 months, cardiovascular EBM rates were significantly lower among MINOCA patients compared to OCD patients. One-year death/re-MI rate was 5.3% in MINOCA and 8.9% in patients with OCD (adjusted hazard ratio (AHR) 0.75, 95% confidence interval (CI) 0.62-0.92, p < 0.0001). Five-year mortality rates were 10.9% in MINOCA and 16.0% in patients with OCD. Upon further stratification, 770 (36.8%) of MINOCA patients had no angiographic evidence of CAD (i.e. normal angiograms). EBM rates were even lower among these patients. One-year death/re-MI rate among these patients was 3.9% as compared to 6.1% among MINOCA patients with stenosis <50% (AHR 0.68, 95% CI 0.44-1.07, p = 0.028). CONCLUSIONS The population-level incidence of MINOCA is approximately 5%. Despite their apparently benign anatomic findings, efforts must be made to improve secondary prevention strategies to reduce the burden of long-term adverse outcomes in this population.
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Affiliation(s)
- Kevin R Bainey
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Robert C Welsh
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Dean Traboulsi
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Todd Anderson
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Neil Brass
- CK Hui Heart Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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191
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Gender is Not a Predictor of Mortality or Major Adverse Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes. Heart Lung Circ 2018; 28:727-734. [PMID: 29705386 DOI: 10.1016/j.hlc.2018.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Historically, studies of percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have reported worse outcomes for women. We sought to determine if contemporary PCI techniques eliminate gender differences in PCI outcomes. METHODS This was a retrospective study of 4,776 consecutive patients who underwent PCI for acute coronary syndromes between January 2008 and July 2015. Primary outcomes studied were major adverse cardiovascular events (MACE) and death at 1year. RESULTS Percutaneous coronary intervention success was similar in men and women (97.8% v 97.7%, p=0.76). There was no significant gender difference in the number of vessels attempted (1.14 vs 1.12, p=0.25), mean number of lesions treated (1.34 vs 1.32, p=0.21) or the mean number of stents used (1.32 vs 1.30, p=0.31). There was equivalent use of drug eluting stents (38.2% vs 38.3%, p=0.94). Women with ST-elevation myocardial infarction STEMI had longer median symptom-to-door time (111 vs 90 mins, p=0.0411) but there was no gender difference in door-to-balloon time or symptom-to-balloon time. There was no significant difference in percentages of women and men <75years treated with prasugrel or ticagrelor (11.1% vs 13.4%, p=0.092). Unadjusted 1-year mortality was 6.4% for women and 4% for men (p=0.0012), but on multivariate analysis, female sex was not a predictor of death. There was no significant gender difference in the overall incidence of unadjusted 1-year MACE (11.6% vs 10.8%, p=0.434). CONCLUSIONS When contemporary PCI techniques are applied equally to men and women with ACS there is no gender difference in mortality or MACE at 1year.
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192
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Parvand M, Rayner-Hartley E, Sedlak T. Recent Developments in Sex-Related Differences in Presentation, Prognosis, and Management of Coronary Artery Disease. Can J Cardiol 2018; 34:390-399. [DOI: 10.1016/j.cjca.2018.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 12/17/2022] Open
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193
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Sederholm Lawesson S, Isaksson RM, Thylén I, Ericsson M, Ängerud K, Swahn E. Gender differences in symptom presentation of ST-elevation myocardial infarction - An observational multicenter survey study. Int J Cardiol 2018; 264:7-11. [PMID: 29642997 DOI: 10.1016/j.ijcard.2018.03.084] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Symptom presentation has been sparsely studied from a gender perspective restricting the inclusion to ST elevation myocardial infarction (STEMI) patients. Correct symptom recognition is vital in order to promptly seek care in STEMI where fast reperfusion therapy is of utmost importance. Female gender has been found associated with atypical presentation in studies on mixed MI populations but it is unclear whether this is valid also in STEMI. OBJECTIVES We assessed whether there are gender differences in symptoms and interpretation of these in STEMI, and if this is attributable to sociodemographic and clinical factors. METHODS SymTime was a multicenter observational study including a validated questionnaire and data from medical records. Eligible STEMI patients (n = 532) were enrolled within 24 h after admittance at five Swedish hospitals. RESULTS Women were older, more often single and had lower educational level. Chest pain was less prevalent in women (74 vs 93%, p < 0.001), whereas shoulder (33 vs 15%, p < 0.001), throat/neck (34 vs 18%, p < 0.001), back pain (29 versus 12%, p < 0.001) and nausea (49 vs 29%, p < 0.001) were more prevalent. Women less often interpreted their symptoms as of cardiac origin (60 vs 69%, p = 0.04). Female gender was the strongest independent predictor of non-chest pain presentation, odds ratio 5.29, 95% confidence interval 2.85-9.80. CONCLUSIONS A striking gender difference in STEMI symptoms was found. As women significantly misinterpreted their symptoms more often, it is vital when informing about MI to the society or to high risk individuals, to highlight also other symptoms than just chest pain.
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Affiliation(s)
- Sofia Sederholm Lawesson
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Rose-Marie Isaksson
- Department of Research, Norrbotten County Council, Luleå, Sweden; Division of Nursing Sciences, Department of Medicine and Health Sciences, Linkoping University, Linköping, Sweden.
| | - Ingela Thylén
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Maria Ericsson
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Karin Ängerud
- Cardiology, Heart Centre, Department of Nursing, Umeå University, Umeå, Sweden.
| | - Eva Swahn
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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194
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4503] [Impact Index Per Article: 750.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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195
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Wang Y, Zhu S, Du R, Zhou J, Chen Y, Zhang Q. Impact of gender on short-term and long-term all-cause mortality in patients with non-ST-segment elevation acute coronary syndromes: a meta-analysis. Intern Emerg Med 2018; 13:273-285. [PMID: 28540660 DOI: 10.1007/s11739-017-1684-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/19/2017] [Indexed: 01/09/2023]
Abstract
A meta-analysis to determine the impact of gender on mortality in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS): PubMed, EMBASE, and Cochrane Library, was systematically searched. Two investigators independently reviewed retrieved articles and assessed eligibility. Unadjusted mortality rates or adjusted effect estimates regarding gender-specific short-term and long-term all-cause mortality were identified. A total of 30 studies involving 358,827 patients with NSTE-ACS (129, 632 women and 229,195 men) were identified. In the unadjusted analysis, women had significantly higher risk of short-term all-cause mortality (RR 1.37; 95% CI 1.26-1.49; P < 0.00001) and long-term all-cause mortality (RR 1.18; 95% CI 1.07-1.31; P = 0.001) compared with men. However, when a meta-analysis was performed using adjusted effect estimates, the association between women and higher risk of short-term mortality (RR 0.99; 95% CI 0.91-1.07; P = 0.74) and long-term all-cause mortality (RR 0.84; 95% CI 0.68-1.03; P = 0.09) was markedly attenuated. Adjusted short-term and long-term all-cause mortality appeared similar in women and men. In conclusion, women with NSTE-ACS have higher short-term and long-term mortality compared with men. However, gender differences do not differ following adjustment for baseline cardiovascular risk factors and clinical differences.
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Affiliation(s)
- Yushu Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Sui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Rongsheng Du
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Juteng Zhou
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
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196
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Couper K, Kimani PK, Gale CP, Quinn T, Squire IB, Marshall A, Black JJM, Cooke MW, Ewings B, Long J, Perkins GD. Variation in outcome of hospitalised patients with out-of-hospital cardiac arrest from acute coronary syndrome: a cohort study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background
Each year, approximately 30,000 people have an out-of-hospital cardiac arrest (OHCA) that is treated by UK ambulance services. Across all cases of OHCA, survival to hospital discharge is less than 10%. Acute coronary syndrome (ACS) is a common cause of OHCA.
Objectives
To explore factors that influence survival in patients who initially survive an OHCA attributable to ACS.
Data source
Data collected by the Myocardial Ischaemia National Audit Project (MINAP) between 2003 and 2015.
Participants
Adult patients who had a first OHCA attributable to ACS and who were successfully resuscitated and admitted to hospital.
Main outcome measures
Hospital mortality, neurological outcome at hospital discharge, and time to all-cause mortality.
Methods
We undertook a cohort study using data from the MINAP registry. MINAP is a national audit that collects data on patients admitted to English, Welsh and Northern Irish hospitals with myocardial ischaemia. From the data set, we identified patients who had an OHCA. We used imputation to address data missingness across the data set. We analysed data using multilevel logistic regression to identify modifiable and non-modifiable factors that affect outcome.
Results
Between 2003 and 2015, 1,127,140 patient cases were included in the MINAP data set. Of these, 17,604 OHCA cases met the study inclusion criteria. Overall hospital survival was 71.3%. Across hospitals with at least 60 cases, hospital survival ranged from 34% to 89% (median 71.4%, interquartile range 60.7–76.9%). Modelling, which adjusted for patient and treatment characteristics, could account for only 36.1% of this variability. For the primary outcome, the key modifiable factors associated with reduced mortality were reperfusion treatment [primary percutaneous coronary intervention (pPCI) or thrombolysis] and admission under a cardiologist. Admission to a high-volume cardiac arrest hospital did not influence survival. Sensitivity analyses showed that reperfusion was associated with reduced mortality among patients with a ST elevation myocardial infarction (STEMI), but there was no evidence of a reduction in mortality in patients who did not present with a STEMI.
Limitations
This was an observational study, such that unmeasured confounders may have influenced study findings. Differences in case identification processes at hospitals may contribute to an ascertainment bias.
Conclusions
In OHCA patients who have had a cardiac arrest attributable to ACS, there is evidence of variability in survival between hospitals, which cannot be fully explained by variables captured in the MINAP data set. Our findings provide some support for the current practice of transferring resuscitated patients with a STEMI to a hospital that can deliver pPCI. In contrast, it may be reasonable to transfer patients without a STEMI to the nearest appropriate hospital.
Future work
There is a need for clinical trials to examine the clinical effectiveness and cost-effectiveness of invasive reperfusion strategies in resuscitated OHCA patients of cardiac cause who have not had a STEMI.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Peter K Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Tom Quinn
- Faculty of Health, Social Care and Education, Kingston University, London and St George’s, University of London, London, UK
| | - Iain B Squire
- University of Leicester and Leicester NIHR Cardiovascular Research Unit, Glenfield Hospital, Leicester, UK
| | | | - John JM Black
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | | | | | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, UK
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197
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Manzo-Silberman S, Couturaud F, Charpentier S, Auffret V, El Khoury C, Le Breton H, Belle L, Marlière S, Zeller M, Cottin Y, Danchin N, Simon T, Schiele F, Gilard M. Influence of gender on delays and early mortality in ST-segment elevation myocardial infarction: Insight from the first French Metaregistry, 2005-2012 patient-level pooled analysis. Int J Cardiol 2018; 262:1-8. [PMID: 29478726 DOI: 10.1016/j.ijcard.2018.02.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population. METHODS AND RESULTS We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility. Primary study outcomes were STEMI, patient and system, delays. Secondary outcome was in-hospital mortality. 16,733 patients were included with 4021 females (24%). Women were significantly older (mean age 70.6 vs 60.6), with higher diabetes (19.6% vs 15.4%) and hypertension rates (58.7% vs 38.8%). Patient delay was longer in women with adjusted mean difference of 14.4 min (p < 0.001); system delay did not differ. In-hospital death occurred 3 times more in women. This disadvantage persisted strongly adjusting for age, therapeutic strategy and delay with a 1.85 (1.32-2.61) adjusted hazard ratio. CONCLUSIONS This overview of 16,733 real-life consecutive STEMI patients in prospective registries over an extensive period strongly indicates gender-related discrepancies, highlighting clinically relevant delays in seeking medical attention. However, higher in-hospital mortality was not totally explained by clinical characteristics or delays. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Department of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France.
| | - Francis Couturaud
- Department of Internal Medicine and Chest Diseases, EA3878, CIC-INSERM1412, Brest University Hospital, European University of Occidental Brittany, Brest, France
| | - Sandrine Charpentier
- Emergency Department, Rangueil University Hospital, Toulouse, France; Toulouse III Paul Sabatier University, Toulouse, France; Team 5, INSERM UMR 1027, Toulouse, France
| | - Vincent Auffret
- Cardiology and Vascular Diseases Department, Rennes University Hospital, Rennes, France; Rennes 1 University, LTSI, Rennes F-35000, France; 3 INSERM, U1099, Rennes, France
| | - Carlos El Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France
| | - Hervé Le Breton
- Cardiology and Vascular Diseases Department, Rennes University Hospital, Rennes, France; Rennes 1 University, LTSI, Rennes F-35000, France; 3 INSERM, U1099, Rennes, France
| | - Loïc Belle
- Cardiology Department, Annecy Hospital, Annecy, France
| | | | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Burgundy, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital, Dijon, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Europeen Georges Pompidou, Paris Hospitals Board (AP-HP), Paris, France; Paris V University, Paris, France
| | - Tabassome Simon
- Department of Pharmacology-URCEST, Paris Hospitals Board (AP-HP), Paris, France; UPMC-Paris 06, Paris, France; INSERM U-1148, Paris, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, Besançon, France
| | - Martine Gilard
- Cardiology Department, Brest University Hospital, EA 4324, European University of Occidental Brittany, Brest, France
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198
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Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality for both women and men. Emerging evidence supports that ischemic heart disease (IHD) may manifest differently in women and men, in ways ranging from the clinical presentation, diagnosis, and management of disease to the basic biology and biomechanics of cardiomyocyte function and the coronary circulation. Women consistently present with a higher burden of symptoms and comorbidities as compared with men and experience worse outcomes. These data have proved perplexing given the decreased likelihood of women to demonstrate obstructive coronary artery disease (CAD) on coronary angiography. Reported sex differences have long been influenced by the practice of defining heart disease primarily as obstructive CAD, but obstructive plaque is now recognized as neither necessary nor sufficient to explain symptoms of IHD, and it is no longer adequate to tailor diagnostic and treatment strategies only to this subset of patients. To date, women remain underrepresented in guideline-changing heart disease research and trials, creating important limitations in the evidence base for cardiovascular medicine. Smaller epicardial coronary arteries in women as compared to men, coupled with differences in shear stress and inflammatory mediators over the life span, may modify the development of CAD in susceptible patients into a diffuse pattern with more contribution from coronary vasomotor dysfunction than focal obstruction. Newer studies corroborate that symptomatic women are more likely than men to present with nonobstructive CAD and coronary microvascular dysfunction. When present, these processes increase cardiovascular risk in both women and men but may constitute an especially malignant phenotype in a subset of severely affected women, with implications for the management of not only CAD but also heart failure with preserved ejection fraction. This represents a state-of-the-art review of sex differences in the coronary system, with an eye toward how diverse pathophysiological processes may contribute to IHD phenotypes prevalent in women and men. Beyond providing women and men with equitable optimal care according to current paradigms, understanding the pathophysiology of IHD beyond a conventional focus on obstructive CAD is needed to address what is likely a combination of biological as well as environmental determinants of their prognosis.
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Affiliation(s)
- Viviany R Taqueti
- Heart and Vascular Center; Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology (Nuclear Medicine and Molecular Imaging), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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199
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Regitz-Zagrosek V. Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women. Korean Circ J 2018; 48:792-812. [PMID: 30146804 DOI: 10.4070/kcj.2018.0249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.
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Affiliation(s)
- Vera Regitz-Zagrosek
- CHARITÉ Universitätsmedizin Berlin, Institute of Gender in Medicine and CCR, and DZHK (partner site Berlin), Berlin, Germany.
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200
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Sun R, Sun L, Fu Y, Liu H, Xu M, Ren X, Yu H, Dong H, Liu Y, Zhu Y, Tian J, Yu B. Culprit plaque characteristics in women vs men with a first ST-segment elevation myocardial infarction: In vivo optical coherence tomography insights. Clin Cardiol 2017; 40:1285-1290. [PMID: 29247510 DOI: 10.1002/clc.22825] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND It is unclear whether more severe coronary atherosclerosis is a prerequisite to an initial acute coronary event in women vs men. HYPOTHESIS Women may have more severe coronary atherosclerosis than men in patients with acute coronary event. METHODS We used intravascular optical coherence tomography (OCT) to evaluate gender differences in culprit-plaque morphology in patients with a first ST-segment elevation myocardial infarction (STEMI).We retrospectively enrolled 211 consecutive patients who experienced a first STEMI and underwent an OCT examination of their infarct-related artery before primary percutaneous coronary intervention. RESULTS Of the 211 patients enrolled, 162 (76.7%) were men and 49 (23.2%) were women. The women were significantly older than the men (mean age, 60.2 ± 8.2 vs 55.7 ± 11.2 years; P = 0.01) and less likely to be current smokers (P = 0.02). Moreover, the delay from symptom onset to reperfusion was longer in women than in men (7.6 ± 6.1 vs 5.5 ± 4.4 hours; P = 0.01). The OCT data indicated that there were no gender differences in culprit-plaque morphology, including lipid length, lipid arc, minimum fibrous cap thickness, or minimum lumen area. Additionally, no gender differences were found in the prevalence of plaque rupture, thin-cap fibroatheroma, residual thrombus, microvessels, macrophages, cholesterol crystals, or calcification. CONCLUSIONS Among patients presenting with a first STEMI, there were no differences in culprit plaque features between women and men.
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Affiliation(s)
- Rong Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Liping Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yandong Fu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huimin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Maoen Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuefeng Ren
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Dong
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yang Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yinchun Zhu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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