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Kim HS, Lee KS, Eun SJ, Choi SW, Kim DH, Park TH, Yun KH, Yang DH, Hwang SJ, Park KS, Kim RB. Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2017; 58:710-719. [PMID: 28540982 PMCID: PMC5447100 DOI: 10.3349/ymj.2017.58.4.710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/22/2017] [Accepted: 03/19/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset. Factors associated with prehospital delay were examined separately by gender using univariate and multivariate analyses. RESULTS Female patients had higher proportions of ≥60-minute decision time and ≥120-minute arrival time compared to male patients (33.9% vs. 23.1%, 60.9% vs. 52.1%, respectively). However, the difference was not statistically significant (p=0.093 and 0.214, respectively). Previous cardiovascular disease (CVD) was associated with increased decision time in men, whereas, in women, lower educational status caused a greater delay in decision time. Factors associated with hospital arrival time excluding delayed decision time were referral from another hospital, previous CVD, and percutaneous coronary intervention in men, and referral from another hospital in women. CONCLUSION Gender differences exist in factors related to prehospital delay. Therefore, public education to reduce prehospital delay should be conducted according to gender with a focus on the pertinent factors.
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Affiliation(s)
- Hee Sook Kim
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital and School of Medicine, Daejeon, Korea
| | - Dae Hyeok Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Tae Ho Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Hospital, Jinju, Korea
| | - Ki Soo Park
- Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea.
| | - Rock Bum Kim
- Center for Regional Cardiocerebrovascular Disease, Gyeongsang National University Hospital, Jinju, Korea.
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Fernández-Rodríguez D, Regueiro A, Cevallos J, Bosch X, Freixa X, Trilla M, Brugaletta S, Martín-Yuste V, Sabaté M, Bosa-Ojeda F, Masotti M. Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart. Med Intensiva 2017; 41:70-77. [DOI: 10.1016/j.medin.2016.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/25/2016] [Accepted: 06/16/2016] [Indexed: 01/30/2023]
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Ghaffari S, Pourafkari L, Tajlil A, Bahmani-Oskoui R, Nader ND. Is female gender associated with worse outcome after ST elevation myocardial infarction? Indian Heart J 2016; 69 Suppl 1:S28-S33. [PMID: 28400036 PMCID: PMC5388020 DOI: 10.1016/j.ihj.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/04/2016] [Accepted: 12/11/2016] [Indexed: 12/26/2022] Open
Abstract
Objectives To investigate the impact of gender in outcomes of patients with ST segment myocardial infarction in a setting with limited access to primary percutaneous coronary intervention Methods In 1017 consecutive patients hospitalized with ST segment myocardial infarction during years 2008–2013, distribution of risk factors, therapeutic methods, heart failure and in-hospital mortality were compared between males and females. Association of gender and primary outcomes was determined after adjustment for confounding factors. Results Females were significantly older (66 ± 12.1 years vs. 59.5 ± 12.7 years, p < 0.001). Prevalence of hypertension, hyperlipidemia and diabetes was significantly higher in females (72.2% vs. 39%, p < 0.001, 36.1% vs. 20.3%, p < 0.001, 46.5% vs. 32.1%, p < 0.001, respectively). Presentation delay was similar in males and females. Females received reperfusion therapy more than males (63.2%vs. 55.8%, p = 0.032). Development of heart failure and in-hospital mortality were significantly higher in females (36.5% vs. 27.2%, p = 0.003 and 19.4% vs. 12.1%, p = 0.002, respectively). However in multivariate analysis, female gender was not independently associated with increased rate of heart failure and in-hospital mortality Conclusion In a center with low rate of primary percutaneous coronary intervention, crude rates of heart failure and in-hospital mortality are higher in females; however, the association is lost after adjustment for baseline characteristics
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Affiliation(s)
- Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Anesthesiology Department, University at Buffalo, Buffalo, NY, United States
| | - Arezou Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roza Bahmani-Oskoui
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Anesthesiology Department, University at Buffalo, Buffalo, NY, United States.
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Gender-related differences in patients with ST-elevation myocardial infarction. Wien Klin Wochenschr 2015; 127 Suppl 5:S263-9. [DOI: 10.1007/s00508-015-0809-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/13/2015] [Indexed: 01/11/2023]
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Fernández-Rodríguez D, Freixa X, Kasa G, Regueiro A, Cevallos J, Hernández M, Brugaletta S, Martín-Yuste V, Sabaté M, Masotti M. [Benefit of the implementation of a ST-segment elevation myocardial infarction network on women]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:96-104. [PMID: 25736036 DOI: 10.1016/j.acmx.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 12/12/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The ST-segment elevation myocardial infarction network "Codi Infart" was implemented in Catalonia (Spain) in June 2009. The objective of this study was to evaluate the impact of the implementation of the Codi Infart on women. METHOD Women referred for primary percutaneous coronary intervention, were divided into two groups according to Codi Infart: Non-Codi Infart group (January 2003 to May 2009) and Codi Infart group (June 2009 to December 2012). Place of first medical contact, time intervals in diagnosis and treatment, treatments received and rate of major cardiovascular adverse events defined as all-cause death, reinfarction or stroke in-hospital, at 30 and 180 days were compared. RESULTS From a total population of 2,426 patients, 501 (20.7%) were women. One-hundred eighty-six women (2.09 cases/month) belonged to Non-Codi Infart group and 315 women (10.16 cases/month) to Codi Infart group. The percentage of women attended increased since the introduction of CI (22.2% vs. 18.5%, P=.028). In addition, the Codi Infart group had a higher percentage of women initially attended outside our institution (84.1% vs. 16.7%, P<.001), and lower total ischemia time (220 [155-380] vs. 272 [196-456], P=.003). However, no differences in 180-day major cardiovascular adverse events were detected (14.2% vs. 15.6%, P=.692). CONCLUSIONS The implementation of the major cardiovascular adverse events allowed to increase the rate and the percentage of women with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention and reducing total ischemic time.
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Affiliation(s)
- Diego Fernández-Rodríguez
- Servicio de Cardiología, Hospital Clínic, Barcelona, España; Servicio de Cardiología, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic, Barcelona, España.
| | - Gizem Kasa
- Servicio de Cardiología, Hospital Clínic, Barcelona, España
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic, Barcelona, España; Comité Directivo, Iniciativa Stent for Life, España
| | | | | | | | | | - Manel Sabaté
- Servicio de Cardiología, Hospital Clínic, Barcelona, España; Comité Directivo, Iniciativa Stent for Life, España
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clínic, Barcelona, España
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van der Meer MG, Nathoe HM, van der Graaf Y, Doevendans PA, Appelman Y. Worse outcome in women with STEMI: a systematic review of prognostic studies. Eur J Clin Invest 2015; 45:226-35. [PMID: 25556757 DOI: 10.1111/eci.12399] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/29/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Treatment of ST elevation myocardial infarction (STEMI) has improved enormously since the introduction of primary percutaneous coronary intervention (pPCI). It remains unclear whether differences in survival between women and men treated with pPCI exist and whether these potential differences can be explained by gender or by differences in baseline- or procedural characteristics. Therefore we systematically reviewed the available evidence. MATERIALS AND METHODS On 10 May 2013 PubMed, Embase and Cochrane were searched for studies comprising original data on STEMI patients treated with pPCI. A separate gender analysis including > 100 women was a requirement. Data were extracted and pooled whenever possible. RESULTS 21 studies were included from 2001 to 2013 comprising 47.439 men and 16.927 women. Women were older, had more diabetes (women 24%, men 15%) and hypertension (women 58%, men 45%), and were less current smokers (women 30%, men 54%). The procedural characteristics were comparable except for a longer symptom-to-balloon time (women 266 min, men 240 min) and less use of GP IIb/IIIa inhibitors in women (women 51%, men 57%). Crude short- and long-term mortality was higher in women. Although we could not pool adjusted mortality proportions due to heterogeneity, generally the difference in mortality disappeared after adjustment for baseline- and procedural characteristics. CONCLUSION Mortality is higher in women with STEMI and can be explained by their unfavourable risk profile and longer symptom-to-balloon time.
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Affiliation(s)
- Manon G van der Meer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Reibis R, Völler H, Gitt A, Jannowitz C, Halle M, Pittrow D, Hildemann S. Management of patients with ST-segment elevation or non-ST-segment elevation acute coronary syndromes in cardiac rehabilitation centers. Clin Cardiol 2014; 37:213-21. [PMID: 24847509 DOI: 10.1002/clc.22241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Current data on the management of patients in cardiac rehabilitation (CR) after an acute hospital stay due to ST-segment elevation or non-ST segment elevation acute coronary syndromes (STE-ACS or NSTE-ACS) are limited. We aimed to describe patient characteristics, risk factor management, and lipid target achievement of patients in CR in Germany and compare the 2 groups. HYPOTHESIS With respect to the risk factor pattern and treatment effects during a CR stay, there are important differences between STE-ACS and NSTE-ACS patients. METHODS Comparison of 7950 patients by STE-ACS or NSTE-ACS status in the Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry (2010) who underwent an inpatient CR period of about 3 weeks. RESULTS STE-ACS patients compared to NSTE-ACS patients were significantly younger (60.5 vs 64.4 years, P < 0.0001), and had diabetes mellitus, hypertension, or any risk factor (exception: smoking) less often. At discharge, in STE-ACS compared to NSTE-ACS patients, the low-density lipoprotein cholesterol (LDL-C) <100 mg/dL goal was achieved by 75.3% and 76.2%, respectively (LDL-C <70 mg/dL by 27.7% and 27.4%), the high-density lipoprotein cholesterol goal of >50 mg/dL in women and >40 mg/dL in men was achieved by 49.3% and 49.0%, respectively, and the triglycerides goal of <150 mg/dl was achieved by 72.3% and 74.3%, respectively (all comparisons not significant). Mean systolic and diastolic blood pressure were 121/74 and 123/74 mm Hg, respectively (P < 0.0001 systolic, diastolic not significant). The maximum exercise capacity was 110 and 102 W, respectively (P < 0.0001), and the maximum walking distance was 581 and 451 meters, respectively (P value not significant). CONCLUSIONS Patients with STE-ACS and NSTE-ACS differed moderately in their baseline characteristics. Both groups benefited from the participation in CR, as their lipid profile, blood pressure, and physical fitness improved.
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Guideline-adherent therapy in patients with acute coronary syndromes. Herz 2014; 40 Suppl 1:27-35. [DOI: 10.1007/s00059-014-4161-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/25/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
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Sabroe JE, Thayssen P, Antonsen L, Hougaard M, Hansen KN, Jensen LO. Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. BMC Cardiovasc Disord 2014; 14:15. [PMID: 24506974 PMCID: PMC3922030 DOI: 10.1186/1471-2261-14-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS From January 1, 2002 to December 31, 2010 all patients with STEMI treated with primary PCI were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounders. RI was defined as creatinine clearance (CrCl) < 60 mL/min (moderate RI: CrCl ≤30 < 60 mL/min and severe RI: CrCl < 30 mL/min). RESULTS The study cohort consisted of 4,116 patients of whom 898 (21.8%) had RI and 3,218 (78.2%) had a CrCl ≥ 60 mL/min. Compared to patients without RI, patients with RI were older, more often female and more likely to have diabetes mellitus, hypertension and to present with a higher Killip class.Among patients with a preserved kidney function and patients with RI, 30-day all-cause mortality was 3.5% vs. 20.9% (log-rank p < 0.001); 1-year all-cause mortality was 5.7% vs. 29.4% (log-rank p < 0.001); 5-year all-cause mortality was 13.4% vs. 47.4% (log-rank p < 0.001). Moderate and severe RI were associated with higher 1-year mortality compared to patients with a preserved renal function (CrCl ≤30 < 60 mL/min: adjusted HR 2.71 [95% CI 2.09-3.51], p < 0.001), and (CrCl < 30 mL/min: adjusted HR 7.09 [4.82-10.44], p < 0.001). CONCLUSION In unselected STEMI patients treated with primary PCI, moderate and severe RI were associated with increased risk of mortality.
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Affiliation(s)
| | | | | | | | | | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Sdr, Boulevard 29, 5000 Odense, Denmark.
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Maier S, Thiele H, Zahn R, Sefrin P, Naber C, Scholz K, von Scheidt W. Empfehlungen zur Organisation von Herzinfarktnetzwerken. DER KARDIOLOGE 2014. [DOI: 10.1007/s12181-013-0540-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Otten AM, Ottervanger JP, Timmer JR, van ’t Hof AWJ, Dambrink JHE, Gosselink ATM, Hoorntje JCA, Suryapranata H, Maas AHEM. Age-dependent differences in diabetes and acute hyperglycemia between men and women with ST-elevation myocardial infarction: a cohort study. Diabetol Metab Syndr 2013; 5:34. [PMID: 23822149 PMCID: PMC3710249 DOI: 10.1186/1758-5996-5-34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/23/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Both acute hyperglycemia as diabetes results in an impaired prognosis in ST-elevation myocardial infarction (STEMI) patients. It is unknown whether there is a different prevalence of diabetes and acute hyperglycemia in men and women within age-groups. METHODS Between 2004 and 2010, 4640 consecutive patients (28% women) with STEMI, were referred for primary PCI. Patients were stratified into two age groups, < 65 years (2447 patients) and ≥65 years (2193 patients). Separate analyses were performed in 3901 patients without diabetes. Diabetes was defined as known diabetes or HbA1c ≥6.5 mmol/l at admission. RESULTS The prevalence of diabetes was comparable between women and men in the younger age group (14% vs 12%, p = 0.52), whereas in the older age group diabetes was more prevalent in women (25% vs 17% p < 0.001). In patients without diabetes, admission glucose was comparable between both genders in younger patients (8.1 ± 2.0 mmol/l vs 8.0 ± 2.2 mmol/l p = 0.36), but in older patients admission glucose was higher in women than in men (8.7 ± 2.1 mmol/l vs 8.4 ± 2.1 mmol/l p = 0.028). After multivariable analyses, the occurrence of increased admission glucose was comparable between men and women in the younger age group (OR 1.1, 95%CI 0.9-1.5), but increased in women in the older age group (OR 1.3, 95% CI 1.1-1.7). Both diabetes and hyperglycemia were associated with a higher one-year mortality in both men and women. CONCLUSIONS The differences between men and women in hyperglycemia and diabetes in patients with STEMI are age dependent and can only be observed in older patients. This may have implications for medical treatment and should be investigated further.
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Affiliation(s)
- Amber M Otten
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - Jan Paul Ottervanger
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - Jorik R Timmer
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - Arnoud WJ van ’t Hof
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - Jan-Henk E Dambrink
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - AT Marcel Gosselink
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - Jan CA Hoorntje
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
| | - Harry Suryapranata
- Isala klinieken, Department of Cardiology, Groot Wezenland 20, Zwolle 8011 JW, The Netherlands
- Department of cardiology, University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Angela HEM Maas
- Department of cardiology, University Medical Center Nijmegen, Nijmegen, the Netherlands
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Juliard JM, Golmard JL, Himbert D, Feldman LJ, Delorme L, Ducrocq G, Descoutures F, Sorbets E, Garbarz E, Boudvillain O, Aubry P, Vahanian A, Steg PG. Comparison of hospital mortality during ST-segment elevation myocardial infarction in the era of reperfusion therapy in women versus men and in older versus younger patients. Am J Cardiol 2013; 111:1708-13. [PMID: 23523063 DOI: 10.1016/j.amjcard.2013.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 01/09/2023]
Abstract
There is intense interest in examining hospital mortality in relation to gender in ST-segment elevation myocardial infarction. The aim of the present study was to determine whether gender influences outcomes in men and women treated with the same patency-oriented reperfusion strategy. The influence of gender on hospital mortality was tested using multivariate analysis and local regression. The influence of age was tested as a continuous and as a categorical variable. In the overall population of 2,600 consecutive patients, gender was not correlated with hospital mortality except in the subgroup of women aged ≥65 years. The risk for death increased linearly in logit scale for men. Up to the age of 65 years, the risk also increased linearly in women but thereafter increased faster than in men. Testing age as a categorical variable, hospital mortality was higher in women than in men aged ≥75 years but was similar between the genders in the younger age categories. In conclusion, despite following an equal patency-oriented management strategy in men and women with ST-segment elevation myocardial infarctions, the risk for hospital death increased linearly with age but with an interaction between age and gender such that older women had an independent increase in hospital mortality. Longer time to presentation and worse baseline characteristics probably contributed to determine a high-risk subset but reinforce the need to apply, as recommended in the international guidelines in the management of patients with ST-segment elevation myocardial infarctions, the same strategy of acute reperfusion in men and women.
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Wijnbergen I, Tijssen J, van 't Veer M, Michels R, Pijls NHJ. Gender differences in long-term outcome after primary percutaneous intervention for ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2013; 82:379-84. [PMID: 23553888 DOI: 10.1002/ccd.24800] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/08/2012] [Accepted: 01/01/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies on gender differences in outcome in patients with ST segment elevation myocardial infarction (STEMI) have been performed, but most of those are from before the current era of PCI technique and medical therapy and have a short duration of follow-up. The objective of our study is to assess the influence of gender on long-term outcome in patients with STEMI who underwent primary percutaneous intervention (PCI) between January 2006 and May 2008. METHODS Two-year follow-up data from 202 female and 668 male patients undergoing primary PCI for STEMI were available from the DEBATER (A Comparison of Drug Eluting and Bare Metal Stents for Primary Percutaneous Coronary Intervention with or without Abciximab in ST-segment elevation Myocardial Infarction: The Eindhoven Reperfusion Study) trial database. The primary endpoint was major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction, and target vessel revascularization. RESULTS Women were older (64.7 ± 11.7 vs. 59.0 ± 10.7; P < 0.001), and had more often diabetes mellitus (15% vs. 9%; P = 0.01) and hypertension (44% vs. 25%; P < 0.001). At two years, the rate of MACE was significantly higher in women (21% vs. 14%; P = 0.02). The mortality rate in women was 8% versus 2.6% in men (P < 0.001). However, multivariate analysis after adjustment for age and the baseline characteristics hypertension, smoking, diabetes mellitus, stent diameter, and time between onset of symptoms and arrival of the ambulance showed similar MACE and mortality rates in men and women. CONCLUSION Women have higher rates of both MACE and mortality after primary PCI for STEMI compared to men because of higher age with higher baseline risk profiles.
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Affiliation(s)
- Inge Wijnbergen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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