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Giordano V, Guillari A, Sansone V, Catone M, Rea T. Women Acute Myocardial Infarction-Identifying and Understanding the Gender Gap (WAMy-GAP): A Study Protocol. Healthcare (Basel) 2024; 12:972. [PMID: 38786384 PMCID: PMC11121322 DOI: 10.3390/healthcare12100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
Barriers to accessing care and misinterpretations of ischemic heart disease symptoms due to lack of awareness contribute to women's delay in seeking care. Women may delay seeking treatment for up to 3 h or even up to 5 days. They often perceive themselves to be at low risk of cardiovascular disease (CVD) and prioritize family responsibilities or household chores. The causes of this delay are multifactorial and influence the decision-making process, particularly in the pre-hospital phase. The objective of this study protocol is to evaluate prodromal symptoms and identify risk behaviors in women with acute myocardial infarction (AMI). This is a protocol for a multicenter study that will be conducted using the mixed-method methodology using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) to evaluate symptoms and semi-structured interviews to investigate behaviors. This study protocol is intended to fill an important knowledge gap on premonitory and acute symptoms of AMI in women in Italy, as well as to understand the causes and mechanisms underlying delays in accessing healthcare services during an acute event such as AMI. The investigation of this issue will facilitate the removal of gender-related inequalities in the diagnosis and treatment of acute myocardial infarction while also fostering dialogue on the barriers to behavior change.
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Affiliation(s)
- Vincenza Giordano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Assunta Guillari
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| | - Vincenza Sansone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Maria Catone
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
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2
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Barton JC, Wozniak A, Scott C, Chatterjee A, Titterton GN, Corrigan AE, Kuri A, Shah V, Soh I, Kaski JC. Between-Sex Differences in Risk Factors for Cardiovascular Disease among Patients with Myocardial Infarction-A Systematic Review. J Clin Med 2023; 12:5163. [PMID: 37568564 PMCID: PMC10420061 DOI: 10.3390/jcm12155163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Between-sex differences in the presentation, risk factors, management, and outcomes of acute myocardial infarction (MI) are well documented. However, as such differences are highly sensitive to cultural and social changes, there is a need to continuously re-evaluate the evidence. The present contemporary systematic review assesses the baseline characteristics of men and women presenting to secondary, tertiary, and quaternary centres with acute myocardial infarction (MI). Over 1.4 million participants from 18 studies, including primary prospective, cross sectional and retrospective observational studies, as well as secondary analysis of registry data are included in the study. The study showed that women were more likely than men to have a previous diagnosis of diabetes, hypertension, cerebrovascular disease, and heart failure. They also had lower odds of presenting with previous ischaemic heart disease and angina, dyslipidaemia, or a smoking history. Further work is necessary to understand the reasons for these differences, and the role that gender-specific risk factors may have in this context. Moreover, how these between-gender differences are implicated in management and outcomes also requires further work.
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Affiliation(s)
- Jack Charles Barton
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Anna Wozniak
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Chloe Scott
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; (A.W.); (C.S.)
| | - Abhisekh Chatterjee
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Greg Nathan Titterton
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | | | - Ashvin Kuri
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (G.N.T.); (A.K.)
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK; (A.C.); (V.S.)
| | - Ian Soh
- St. George’s University of London, London SW17 0RE, UK;
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London SW17 0RE, UK;
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3
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Lunova T, Komorovsky R, Klishch I. Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Curr Cardiol Rev 2023; 19:e300622206530. [PMID: 35786190 PMCID: PMC10201882 DOI: 10.2174/1573403x18666220630120259] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS), with respect to treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS. METHODS We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately. RESULTS Women with ACS more often experienced delays in treatment compared to men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs. CONCLUSION Women with ACS experience a delay in time to treatment more often than men. They are also less likely to be treated invasively. Females have shown worse crude short-and long-term all-cause mortality compared to males. However, after adjustment for multiple covariates, a less significant gender difference has been observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations on gender-related influence of particular risk factors on the outcomes of ACS.
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Affiliation(s)
- Tetiana Lunova
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Roman Komorovsky
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Ivan Klishch
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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4
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O’Connor CT, Ibrahim A, Buckley A, Maguire C, Kumar R, Kumar J, Arnous S, Kiernan TJ. Total ischaemic time in STEMI: factors influencing systemic delay. THE BRITISH JOURNAL OF CARDIOLOGY 2022; 29:17. [PMID: 36212786 PMCID: PMC9534116 DOI: 10.5837/bjc.2022.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Total ischaemic time in ST-elevation myocardial infarction (STEMI) has been shown to be a predictor of mortality. The aim of this study was to assess the total ischaemic time of STEMIs in an Irish primary percutaneous coronary intervention (pPCI) centre. A single-centre prospective observational study was conducted of all STEMIs referred for pPCI from October 2017 until January 2019. There were 213 patients with a mean age 63.9 years (range 29-96 years). The mean ischaemic time was 387 ± 451.7 mins. The mean time before call for help (patient delay) was 207.02 ± 396.8 mins, comprising the majority of total ischaemic time. Following diagnostic electrocardiogram (ECG), 46.5% of patients had ECG-to-wire cross under 90 mins as per guidelines; 73.9% were within 120 mins and 93.4% were within 180 mins. Increasing age correlated with longer patient delay (Pearson's r=0.2181, p=0.0066). Women exhibited longer ischaemic time compared with men (508.96 vs. 363.33 mins, respectively, p=0.03515), driven by a longer time from first medical contact (FMC) to ECG (104 vs. 34 mins, p=0.0021). The majority of total ischaemic time is due to patient delay, and this increases as age increases. Women had longer ischaemic time compared with men and longer wait from FMC until diagnostic ECG. This study suggests that improved awareness for patients and healthcare staff will be paramount in reducing ischaemic time.
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Affiliation(s)
- Cormac T O’Connor
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Abdallah Ibrahim
- Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Anthony Buckley
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Caoimhe Maguire
- Medical Registrar Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Jatinder Kumar
- Interventional Fellow Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Samer Arnous
- Consultant Cardiologist Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas J Kiernan
- Associate Professor of Medicine Department of Cardiology, University Hospital Limerick, Limerick, IrelandXS
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5
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Paradossi U, Taglieri N, Massarelli G, Palmieri C, De Caterina AR, Bruno AG, Taddei A, Nardi E, Ghetti G, Palmerini T, Trianni G, Mazzone A, Pizzi C, Donati F, Bendandi F, Marrozzini C, Ravani M, Galiè N, Saia F, Berti S. Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI. J Cardiovasc Med (Hagerstown) 2022; 23:234-241. [PMID: 35081074 DOI: 10.2459/jcm.0000000000001300] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate gender difference in mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (PPCI). METHODS We analyzed data from the prospective registries of two hub PPCI centres over a 10-year period to assess the role of female gender as an independent predictor of both all-cause and cardiac death at 30 days and 1 year. To account for all confounding variables, a propensity score (PS)-adjusted multivariable Cox regression model and a PS-matched comparison between the male and female were used. RESULTS Among 4370 consecutive STEMI patients treated with PPCI at participating centres, 1188 (27.2%) were women. The survival rate at 30 days and 1 year were significantly lower in women (Log-rank P-value < 0.001). At PS-adjusted multivariable Cox regression analysis, female gender was independently associated with an increased risk of 30-day all-cause death [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.45-3.01, P < 0.001], 30-day cardiac death (HR = 2.03;95% CI:1.41-2.93, P < 0.001), 1-year all-cause death (HR = 1.45; 95% CI:1.16-1.82, P < 0.001) and 1-year cardiac death (HR = 1.51; 95% CI:1.15-1.97, P < 0.001). For the study outcome, we found a significant interaction of gender with the multivessel disease in females who were at increased risk of mortality in comparison with men in absence of multivessel disease. After the PS matching procedure, a subset of 2074 patients were identified. Women still had a lower survival rate and survival free from cardiac death rate both at 30-day and at 1-year follow-up. CONCLUSION As compared with men, women with STEMI treated with PPCI have higher risk of both all-cause death and cardiac mortality at 30-day and 1-year follow-up.
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Affiliation(s)
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Massarelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Donati
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Bendandi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sergio Berti
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, Massa
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6
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Lansky A, Baron SJ, Grines CL, Tremmel JA, Al-Lamee R, Angiolillo DJ, Chieffo A, Croce K, Jacobs AK, Madan M, Maehara A, Mehilli J, Mehran R, Ng V, Parikh PB, Saw J, Abbott JD. SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100016. [PMID: 39132570 PMCID: PMC11307953 DOI: 10.1016/j.jscai.2021.100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Affiliation(s)
| | | | - Cindy L. Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | | | | | - Alaide Chieffo
- University of Florida Health Sciences Center, Jacksonville, Florida
| | - Kevin Croce
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Alice K. Jacobs
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Akiko Maehara
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Ng
- Columbia University Irving Medical Center, New York, New York
| | - Puja B. Parikh
- Stony Brook University Medical Center, Stony Brook, New York
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - J. Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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7
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Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences. Cancers (Basel) 2022; 14:cancers14020434. [PMID: 35053596 PMCID: PMC8774086 DOI: 10.3390/cancers14020434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cardiovascular disease and cancer are the leading causes of hospitalization and mortality in high-income countries. Studies of myocardial infarction show a disadvantage for the female sex in terms of survival and development of heart failure after myocardial infarction. The extent to which this also applies to the co-occurrence of coronary heart disease and cancer was investigated and analyzed here in large registry studies. Particular attention has been paid to the four most common cancers and hematologic diseases associated with coronary artery disease requiring treatment. Abstract Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.
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8
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Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The effect of sex on door-to-balloon time in patients presenting with ST-elevation myocardial infarction and referred for primary percutaneous coronary intervention: A systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:120-127. [PMID: 34334335 DOI: 10.1016/j.carrev.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Timely reperfusion using primary percutaneous coronary intervention (pPCI) is the cornerstone of acute ST-elevation myocardial infarction (STEMI) management. We conducted a systematic review to examine the effect of sex on door-to-balloon (D2B) time and symptom-to-balloon (S2B) time. We observed longer D2B times and S2B times in female patients presenting with STEMI and referred for pPCI when compared to male patients. Future work is required to try and elucidate and mitigate sex-based front-line treatment delays for female STEMI patients.
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Affiliation(s)
- Corinne S Babiolakis
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Shubham Sharma
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Nawid Sayed
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Joseph G Abunassar
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| | - Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia.
| | - Wael Abuzeid
- Division of Cardiology, Queen's University/Kingston Health Sciences Centre - Kingston General Hospital Site, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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9
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Sambola A, Elola FJ, Buera I, Fernández C, Bernal JL, Ariza A, Brindis R, Bueno H, Rodríguez-Padial L, Marín F, Barrabés JA, Hsia R, Anguita M. Sex bias in admission to tertiary-care centres for acute myocardial infarction and cardiogenic shock. Eur J Clin Invest 2021; 51:e13526. [PMID: 33621347 DOI: 10.1111/eci.13526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/17/2021] [Accepted: 02/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are limited data on sex-specific outcomes and management of cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). We investigated whether any sex bias exists in the admission to revascularization capable hospitals (RCH) or intensive cardiac care units (ICCU) and its impact on in-hospital mortality. METHODS We used the Spanish National Health System Minimum Basic Data from 2003 to 2015 to identify patients with CS-STEMI. The primary outcome was sex differences in in-hospital mortality. RESULTS Among 340 490 STEMI patients, 20 262 (6%) had CS and 29.2% were female. CS incidence was higher in women than in men (7.9% vs 5.1%, P = .001). Women were older and had more hypertension and diabetes, and were less often admitted to RCH than men (from 58.7% in 2003 to 79.6% in 2015; and from 61.9% in 2003 to 85.3% in 2015; respectively, P = .01), and to ICCU centres (25.7% vs 29.2%, P = .001). Adjusted mortality was higher in women than men over time (from 79.5 ± 4.3% to 65.8 ± 6.5%; and from 67.8 ± 6% to 58.1 ± 6.5%; respectively, P < .001). ICCU availability was associated with higher use of Percutaneous coronary intervention (PCI) in women (46.8% to 67.2%; P < .001) but was even higher in men (54.8% to 77.4%; P < .001). In ICCU centres, adjusted mortality rates decreased in both sexes, but lower in women (from 74.9 ± 5.4% to 66.3 ± 6.6%) than in men (from 67.8 ± 6.0% to 58.1 ± 6.5%, P < .001). Female sex was an independent predictor of mortality (OR 1.18 95% CI 1.10-1.27, P < .001). CONCLUSIONS Women with CS-STEMI were less referred to tertiary-care centres and had a higher adjusted in-hospital mortality than men.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | | | - Irene Buera
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | - Cristina Fernández
- Foundation Institute for Healthcare Improvement, Madrid, Spain.,Department of Preventive Medicine, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - José Luis Bernal
- Foundation Institute for Healthcare Improvement, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Albert Ariza
- CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain.,Heart Diseases Institute, Hospital Universitario de Bellvitge -IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ralph Brindis
- Department of Medicine & The Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Héctor Bueno
- CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain.,Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francisco Marín
- Hospital Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - José Antonio Barrabés
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.,CIBER de enfermedades CardioVasculares (CIBER-CV), Barcelona, Spain
| | - Renee Hsia
- Health Policy Studies in the Department of Emergency Medicine at University of California, San Francisco, CA, USA
| | - Manuel Anguita
- Department of Cardiology, Hospital Universitario Reina Sofía de Cordoba, Córdoba, Spain
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10
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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11
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Kimura T, Akahori H, Asakura M, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Wake M, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Toubara T, Saku K, Oshima S, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. Impact of Age on Gender Difference in Long-term Outcome of Patients With Acute Myocardial Infarction (from J-MINUET). Am J Cardiol 2021; 142:5-13. [PMID: 33279486 DOI: 10.1016/j.amjcard.2020.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Although gender difference in long-term outcomes after acute myocardial infarction have been shown previously, impact of age on gender difference is still controversial. This study focused on the association between age and gender difference in long-term outcome. We analyzed data from 3,283 consecutive patients who were included in a prospective, nationwide, multicenter registry (Japan Registry of Acute Myocardial Infarction Diagnosed by Universal Definition) from 2012 to 2014. The primary end point was the major adverse cardiovascular event (MACE), which was defined as a composite of death, myocardial infarction, stroke, heart failure, and revascularization for unstable angina during 3 years. Patients were divided into 4 strata according to age: those with age <65 years (group 1: n = 1161), 65 to 74 years (group 2: n = 954), 75 to 84 years (group 3: n = 866) and 84< years (group 4: n = 302). Although the crude incidence of 3-year MACE was significantly higher in women than men (36.4% vs. 28.5%, p <0.001), there was not significant gender difference in each group (group 1, 19.6% vs 19.0%, p = 0.74; group 2, 33.1% vs 28.3%, p = 0.25; group 3, 38.9% vs 39.6%, p = 0.54; and group 4, 54.0% vs 56.8%, p = 0.24). In conclusion, although women had higher crude incidence of 3-year MACE than men, there was no gender difference in each group.
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12
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Outcomes and Procedural Considerations for Women Undergoing PCI. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Alharbi MS, Alanazi BK, Alquhays IA, Alhamied NA, Al Shimemeri A. Effect of Gender on the Outcomes of ST-Elevation Myocardial Infarction at a Tertiary Care Hospital in Riyadh, Saudi Arabia. Cureus 2020; 12:e10118. [PMID: 33005534 PMCID: PMC7523745 DOI: 10.7759/cureus.10118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective This study aimed to evaluate the impact of gender on the outcomes among ST elevation myocardial infarction patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Methods This retrospective study analyzed the data of 900 patients (770 males and 130 females) admitted between January 2016 and December 2018 diagnosed with ST-elevation myocardial infarction (STEMI). We recorded the baseline characteristics, comorbidities, treatment, complications, and mortality for all patients, and compared these data between female and male patients. Results The baseline characteristics: BMI and age were higher in females and were statistically significant (p = 0.0001). We found a higher incidence of heart failure in females than in males which was statistically significant (p = 0.0010). In addition, the mortality rate was higher in female than in male patients, although this difference was not statistically significant (p = 0.3850). Conclusion In conclusion, despite the advances in the technology and the use of novel reperfusion therapies females were associated with poorer outcomes after adjustment of the baseline characteristics and risk factors. In other words, heart failure, mitral regurgitation, and arrhythmias were higher in females with significant p values.
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Affiliation(s)
| | | | | | - Nawaf A Alhamied
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah Al Shimemeri
- Internal Medicine: Critical Care, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Evaluation of sex differences in patients with ST-elevated myocardial infarction: an observational cohort study in Amsterdam and surrounding region. Neth Heart J 2020; 28:595-603. [PMID: 32529555 PMCID: PMC7596126 DOI: 10.1007/s12471-020-01435-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Women with ST-elevation myocardial infarction (STEMI) present with different symptoms compared to men. This can result in delays in diagnosis and in the timely treatment of women. The aim of this study is to examine these differences, including the short- and long-term mortality in women and men. Methods This quality registry study included all patients with STEMI who received primary percutaneous coronary intervention in 2015 or 2016 in Amsterdam and the surrounding region. Results Three PCI centres and the Emergency Medical Service in Amsterdam participated. In total, 558 men (71%) and 229 women (29%) were included. Women were on average 7 years older than men (68 vs 61 years, p < 0.001), and suffered more often from hypertension (46% vs 34%, p = 0.002) and monovascular disease (69% vs 57%, p = 0.002). A higher percentage of men were current smokers (41% vs 49%, p = 0.043). Patient delay, system delay and overall ischaemic times were similar in both women and men (medians: 51, 94 and 157 min, respectively). Initiation of treatment was achieved within 90 min after STEMI diagnosis in 85% of patients (87% in women, 85% in men). Thirty-day and 1‑year mortality adjusted hazard ratio for women versus men was 1.60 (95% CI 0.9–3.0) and 1.24 (95% CI 0.8–2.0), respectively. Discussion Recognition of cardiac complaints remains challenging for patients. In the Amsterdam region, time delays and mortality were not significantly different between men and women presenting with STEMI. These results are in contrast to findings in similar registries. This suggests that implementation of current knowledge and national campaigns are effective in increasing awareness of the signs and symptoms suggestive of myocardial infarction.
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15
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Manzo-Silberman S. Percutaneous coronary intervention in women: is sex still an issue? Minerva Cardioangiol 2020; 68:393-404. [PMID: 32326680 DOI: 10.23736/s0026-4725.20.05203-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary artery disease among women presents differences in terms of clinical presentation and pathophysiology. To date, women present worse prognoses with more events and higher mortality rate. One the one hand, they are less likely addressed for invasive therapy. One the other hand, revascularization procedures, whether by bypass or by percutaneous coronary intervention, are associated with higher rates of complications and poorer prognosis. Despite higher risk factor burden and comorbidity, women are less affected by obstructive disease and plaque characteristics are more favorable than among men. Abnormalities of endothelial function and micro vascular flow reserve could explain part of the high prevalence of symptoms of angina observed among women. Due to the worse prognosis of microvascular dysfunction, particularly in women, proper diagnosis is mandatory and deserve invasive management. Outcome following ST elevation myocardial infarction is still more severe among women with higher in-hospital mortality, but sex discrepancies are observed even in elective percutaneous coronary intervention. However, improvement of techniques, drugs and devices benefited to both men and women and tend to decrease gender gap. Especially, changes in the design of newer-generation drug-eluting stents (DES) may be particularly important for women. Female sex remains a potent predictor of higher risk of bleeding and vascular complication; thus important efforts should be promoted to develop bleeding avoidance strategies. Sex-based differences still deserve dedicated investigations in terms of physiopathology, particular hormonal impacts, and specific responses to drugs and devices.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Service of Cardiology, Lariboisière University Hospital, Paris, France - .,UMRS 942, University of Paris, Paris, France -
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16
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Jackson AM, Zhang R, Findlay I, Robertson K, Lindsay M, Morris T, Forbes B, Papworth R, McConnachie A, Mangion K, Jhund PS, McCowan C, Berry C. Healthcare disparities for women hospitalized with myocardial infarction and angina. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:156-165. [PMID: 31346604 PMCID: PMC7132925 DOI: 10.1093/ehjqcco/qcz040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Abstract
AIMS Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. METHODS AND RESULTS We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37-1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52-1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P < 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16-2.56] and 1 year (adjusted HR 1.38, CI 1.12-1.69). CONCLUSION After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.
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Affiliation(s)
- Alice M Jackson
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Ruiqi Zhang
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Iain Findlay
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
| | - Keith Robertson
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley PA2 9PN, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
| | - Mitchell Lindsay
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
| | | | - Brian Forbes
- AstraZeneca UK, Capability Green, Luton LU1 3LU, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK
| | - Kenneth Mangion
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
| | - Colin McCowan
- School of Medicine, Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
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17
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Rubini Gimenez M, Zeymer U, Desch S, de Waha-Thiele S, Ouarrak T, Poess J, Meyer-Saraei R, Schneider S, Fuernau G, Stepinska J, Huber K, Windecker S, Montalescot G, Savonitto S, Jeger RV, Thiele H. Sex-Specific Management in Patients With Acute Myocardial Infarction and Cardiogenic Shock: A Substudy of the CULPRIT-SHOCK Trial. Circ Cardiovasc Interv 2020; 13:e008537. [PMID: 32151161 DOI: 10.1161/circinterventions.119.008537] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Women are more likely to suffer and die from cardiogenic shock (CS) as the most severe complication of acute myocardial infarction. Data concerning optimal management for women with CS are scarce. Aim of this study was to better define characteristics of women experiencing CS and to the influence of sex on different treatment strategies. METHODS In the CULPRIT-SHOCK trial (The Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock), patients with CS complicating acute myocardial infarction and multivessel coronary artery disease were randomly assigned to one of the following revascularization strategies: either percutaneous coronary intervention of the culprit-lesion-only or immediate multivessel percutaneous coronary intervention. Primary end point was composite of death from any cause or severe renal failure leading to renal replacement therapy within 30 days. We investigated sex-specific differences in general and according to the revascularization strategies. RESULTS Among all 686 randomized patients included in the analysis, 24% were women. Women were older and had more often diabetes mellitus and renal insufficiency, whereas they had less often history of previous acute myocardial infarction and smoking. After 30 days, the primary clinical end point was not significantly different between groups (56% women versus 49% men; odds ratio, 1.29 [95% CI, 0.91-1.84]; P=0.15). There was no interaction between sex and coronary revascularization strategy regarding mortality and renal failure (Pinteraction=0.11). The primary end point occurred in 56% of women treated by the culprit-lesion-only strategy versus 42% men, whereas 55% of women and 55% of men in the multivessel percutaneous coronary intervention group. CONCLUSIONS Although women presented with a different risk profile, mortality and renal replacement were similar to men. Sex did not influence mortality and renal failure according to the different coronary revascularization strategies. Based on these data, women and men presenting with CS complicating acute myocardial infarction and multivessel coronary artery disease should not be treated differently. However, further randomized trials powered to address potential sex-specific differences in CS are still necessary. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01927549.
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Affiliation(s)
- Maria Rubini Gimenez
- From the Department of Internal Medicine/Cardiology, Heart Center Leipzig, Germany (M.R.G., S.D., H.T.).,Cardiology Department, University Hospital Basel, Switzerland (M.R.G., R.V.J.)
| | | | - Steffen Desch
- From the Department of Internal Medicine/Cardiology, Heart Center Leipzig, Germany (M.R.G., S.D., H.T.).,German Center for Cardiovascular Research, Berlin, Germany (S.D., R.M.-S., G.F.)
| | - Suzanne de Waha-Thiele
- Department of Internal Medicine/Cardiology/ Angiology/Intensive Care Medicine, University Heart Center Lübeck, Germany (S.d.W.-T., J.P., R.M.-S., G.F.)
| | - Taoufik Ouarrak
- Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., S.S.)
| | - Janine Poess
- Department of Internal Medicine/Cardiology/ Angiology/Intensive Care Medicine, University Heart Center Lübeck, Germany (S.d.W.-T., J.P., R.M.-S., G.F.)
| | - Roza Meyer-Saraei
- German Center for Cardiovascular Research, Berlin, Germany (S.D., R.M.-S., G.F.).,Department of Internal Medicine/Cardiology/ Angiology/Intensive Care Medicine, University Heart Center Lübeck, Germany (S.d.W.-T., J.P., R.M.-S., G.F.)
| | - Steffen Schneider
- Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., S.S.)
| | - Georg Fuernau
- German Center for Cardiovascular Research, Berlin, Germany (S.D., R.M.-S., G.F.).,Department of Internal Medicine/Cardiology/ Angiology/Intensive Care Medicine, University Heart Center Lübeck, Germany (S.d.W.-T., J.P., R.M.-S., G.F.)
| | | | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical School, Vienna, Austria (K.H.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (S.W.)
| | - Gilles Montalescot
- Department of Cardiology, Sorbonne Université, Institut de Cardiologie (AP-HP), hôpital Pitié Salpêtrière, Paris, France (G.M.)
| | | | - Raban V Jeger
- Cardiology Department, University Hospital Basel, Switzerland (M.R.G., R.V.J.)
| | - Holger Thiele
- From the Department of Internal Medicine/Cardiology, Heart Center Leipzig, Germany (M.R.G., S.D., H.T.)
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18
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Dar M, Sharma A, Iqbal M, Tramboo N. Gender-based differences in coronary artery disease: A prospective observational study from a North Indian state. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_13_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Reuter PG, Pradeau C, Huo Yung Kai S, Lhermusier T, Bourdé A, Tentillier E, Combes X, Bongard V, Ducassé JL, Charpentier S. Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre. Scand J Trauma Resusc Emerg Med 2019; 27:92. [PMID: 31623657 PMCID: PMC6798370 DOI: 10.1186/s13049-019-0670-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender. We aimed to establish and validate a sex-based model to predict a coronary origin of chest pain in patients calling an EMCC. Methods This prospective cohort study enrolled patients at 18 years of age or older who called the EMCC because of non-traumatic chest pain. The main outcome was the diagnosis of acute coronary syndrome (ACS) determined by expert evaluation of patient files. Results During 18 months, 3727 patients were enrolled: 2097 (56%) men and 1630 (44%) women. ACS was diagnosed in 508 (24%) men and 139 (9%) women. For men, independent factors associated with an ACS diagnosis were age, tobacco use, severe and permanent pain; retrosternal, breathing non-related and radiating pain; and additional symptoms. The area under the receiver operating characteristic curve (AUC) was 0.76 (95% confidence interval [CI] 0.73–0.79) for predicting ACS. The accuracy of the male model to predict ACS was validated in a validation dataset (Hosmer-Lemeshow test: p = 0.554); the AUC was 0.77 (95%CI 0.73–0.80). For women, independent factors associated with an ACS diagnosis were age ≥ 60 years, personal history of coronary artery disease, and breathing non-related and radiating pain. The AUC was 0.79 (95%CI 0.75–0.83). The accuracy of the female model to predict ACS was not validated in the validation dataset (Hosmer-Lemeshow test: p = 0.035); the AUC was 0.67 (95%CI 0.60–0.74). Conclusions Predictors of an ACS diagnosis in patients calling an EMCC for chest pain differ between men and women. We developed an accurate predictive model for men, but for women, the accuracy was poor. Trial registration This study is registered with ClinicalTrials.gov (NCT02042209).
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Affiliation(s)
- Paul-Georges Reuter
- Emergency Department, Toulouse University Hospital, 31000, Toulouse, France. .,UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France. .,SAMU 92, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, 92380, Garches, France.
| | | | - Samantha Huo Yung Kai
- UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche (USMR), Centre Hospitalier Universitaire de Toulouse (CHU de Toulouse), Toulouse, France
| | | | - Arnaud Bourdé
- Department of Emergency, CHU de la Réunion, allée des Topazes, Université de la Réunion, 97400, Saint Denis, France
| | | | - Xavier Combes
- Department of Emergency, CHU de la Réunion, allée des Topazes, Université de la Réunion, 97400, Saint Denis, France
| | - Vanina Bongard
- UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche (USMR), Centre Hospitalier Universitaire de Toulouse (CHU de Toulouse), Toulouse, France
| | - Jean-Louis Ducassé
- Emergency Department, Toulouse University Hospital, 31000, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31000, Toulouse, France.,UMR 1027, Paul Sabatier University Toulouse III, Inserm, Toulouse, France
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20
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Kanic V, Suran D, Krajnc I, Kompara G. ST-elevation myocardial infarction in a real world population - An observational retrospective study with a sex perspective. Eur J Intern Med 2019; 66:81-84. [PMID: 31200997 DOI: 10.1016/j.ejim.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/05/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Mortality after myocardial infarction is higher in women than in men. Data on the association between sex and mortality are conflicting and inconclusive. We evaluated whether there is a sex difference in survival and if sex is associated with the outcome in patients with ST-elevation myocardial infarction (STEMI). METHODS We analyzed 3671 STEMI patients. Long-term and 30-day mortality in men and women were compared. RESULTS Unadjusted mortality at day 30 was higher in women [221 (8.7%) men died compared to 147 (13.1%) women; p < 0.0001]. After multivariate adjustments, this became insignificant (OR 1.65; 95% CI; 0.81 to 1.40). The long-term, unadjusted mortality was also higher in women [674 (26.3%) men died compared to 382 (34%) women; p < 0.0001]. After multivariable adjustments, female sex (adjusted HR 0.81; 95% CI 0.71 to 0.93; p = 0.002), bleeding (adjusted HR 1.79; 95% CI 1.52 to 2.10; p < 0.0001), renal dysfunction adjusted HR (1.60; 95% CI 1.40 to 1.84; p < 0.0001), hyperlipidemia (adjusted HR 1.61; 95% CI 1.40 to 1.85; p < 0.0001), arterial hypertension (adjusted HR 1.17; 95% CI 1.03 to 1.33; p = 0.015), diabetes (adjusted HR 1.55; 95% CI 1.35 to 1.78; p < 0.0001), age (adjusted HR 1.05; 95% CI 1.04 to 1.06; p < 0.0001), anemia on admission (adjusted HR 1.38; 95% CI 1.23 to 1.58; p < 0.0001), and heart failure (adjusted HR 2.40; 95% CI 2.09 to 2.75; p < 0.0001) predicted long-term mortality. CONCLUSION Female sex was associated with a lower risk of dying in the long term. However, risk factors, age, and comorbidities associated with female patients affected the worse outcome.
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Affiliation(s)
- Vojko Kanic
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - David Suran
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Igor Krajnc
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Gregor Kompara
- University Medical Center Maribor, Department of Cardiology and Angiology, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
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Nagumo S, Mori H, Maeda A, Akashi YJ, Ako J, Ikari Y, Ebina T, Sato N, Tamura K, Namiki A, Fukui K, Michishita I, Kimura K, Suzuki H. Sex-Related Differences in In-Hospital Mortality in Japanese ST-Elevation Acute Myocardial Infarction Patients Presenting to Hospital in the 24 Hours After Symptom Onset - Results From K-ACTIVE. Circ Rep 2019; 1:313-319. [PMID: 33693156 PMCID: PMC7892487 DOI: 10.1253/circrep.cr-19-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background:
Despite the drastic advances in clinical care for patients with acute ST-elevation myocardial infarction (STEMI), female STEMI patients have higher in-hospital mortality rates than male patients. This study assessed the influence of sex on in-hospital mortality in STEMI patients in Kanagawa Prefecture, Japan. Methods and Results:
From October 2015 to June 2018, 2,491 consecutive STEMI patients (23.9% female) who presented to hospital in the 24 h after symptom onset were analyzed. The female patients were 9 years older and less frequently had diabetes, smoking and prior MI than male patients. Pre-hospital managements, including prehospital 12-lead electrocardiography, and symptom-to-door time were similar between the sexes. A door-to-device time ≤90 min was achieved in 61.3% of female cases and in 65.0% of male cases (P=0.13). Reperfusion therapy was provided to 94.6% of female and 97.6% of male patients (P<0.001). In-hospital mortality rate was not significantly different between female and male patients (6.6% vs. 7.8%, P=0.37). On multivariate logistic regression analysis, female sex itself was not associated with in-hospital mortality (OR, 1.52; 95% CI: 0.67–3.47, P=0.32). Conclusions:
There was no sex discrepancy in the in-hospital mortality of STEMI patients in this study. Guideline-based treatment, such as advanced pre-hospital management and a high use of reperfusion therapy might have attenuated the sex-related differences in the in-hospital mortality.
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Affiliation(s)
- Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University Hospital Tokyo Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine Isehara Japan
| | - Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center Yokohama Japan
| | - Naoki Sato
- Division of Cardiology, Nippon Medical University Musashi Kosugi Hospital Kawasaki Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital Kawasaki Japan
| | - Kazuki Fukui
- Department of Cardiovascular Medicine, Kanagawa Cardiovascular and Respiratory Center Yokohama Japan
| | - Ichiro Michishita
- Division of Cardiology, Yokohama Sakae Kyosai Hospital Yokohama Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan
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Rao U, Buchanan GL, Hoye A. Outcomes After Percutaneous Coronary Intervention in Women: Are There Differences When Compared with Men? ACTA ACUST UNITED AC 2019; 14:70-75. [PMID: 31178932 PMCID: PMC6545995 DOI: 10.15420/icr.2019.09] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Despite advances in the diagnosis and treatment of coronary artery disease, there remains evidence of a disparity in the outcomes for women when compared with men. This article provides a review of the evidence for this discrepancy and discusses some of the potential contributing factors.
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Affiliation(s)
- Usha Rao
- Department of Cardiology, Castle Hill Hospital Kingston upon Hull, UK
| | - G Louise Buchanan
- Department of Cardiology, Cumberland Infirmary, Newtown Road Carlisle, UK
| | - Angela Hoye
- Department of Cardiology, Castle Hill Hospital Kingston upon Hull, UK
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Ten Haaf ME, Bax M, Ten Berg JM, Brouwer J, Van't Hof AW, van der Schaaf RJ, Stella PR, Tjon Joe Gin RM, Tonino PA, de Vries AG, Zijlstra F, Boersma E, Appelman Y. Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands. Neth Heart J 2019; 27:263-271. [PMID: 30989470 PMCID: PMC6470244 DOI: 10.1007/s12471-019-1271-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands. METHODS This registry is a merge of available data on ACS patients in the electronic data capture systems of 11 centres with 24/7 interventional cardiology services. We included patients >18 years undergoing a cardiac catheterisation between 2010-2012. We evaluated sex differences in clinical and procedural characteristics and 1‑year mortality. RESULTS A total of 29,265 ACS patients (8,720 women and 20,545 men) were registered. Women were on average 4.5 years older (68.5 vs 63.0 years, p < 0.001) and had a higher prevalence of hypertension (62.7 vs 49.8%, p < 0.001) and insulin-dependent diabetes mellitus (9.6 vs 6.8%, p < 0.001) than men. Women less often presented with ST-elevation myocardial infarction (43.7% vs 47.6%, p < 0.001) and appeared to have less extensive coronary artery disease than men. Women less often underwent coronary angiography by radial access (52.5 vs 55.9%, p < 0.001). One-year mortality was higher in women than in men (7.3% and 5.6%, p < 0.001). More specific, the relationship between sex and mortality was age-dependent and showed higher mortality in women ≤71 years, but lower mortality in older women compared with men (p-interaction <0.001). CONCLUSION We found differences in clinical and procedural characteristics and outcome between women and men admitted for ACS, which are in line with other Western countries. The limitations of our registry, based on existing local databases, can be overcome by the use of the prospective Netherlands Heart Registry that is currently in development.
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Affiliation(s)
- M E Ten Haaf
- Department of Cardiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands.
- The Netherlands Heart Institute, Utrecht, The Netherlands.
| | - M Bax
- Department of Cardiology, HAGA Hospital, The Hague, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Brouwer
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A W Van't Hof
- Department of Cardiology, MUMC, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland MC, Heerlen, The Netherlands
| | - R J van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis location East, Amsterdam, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R M Tjon Joe Gin
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - P A Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A G de Vries
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - F Zijlstra
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
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Gender-Related Particularities in Acute Myocardial Infarction – a Study on a Patient Cohort from North East Romania. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.2478/jce-2018-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Introduction: Cardiovascular disease is the leading cause of death among women irrespective of race or ethnicity, and about half of these deaths are caused by coronary artery disease. Several studies have reported that cardiovascular diseases manifest themself with a delay of about 7–10 years in women and that they have higher in-hospital mortality. It has not yet been established whether female gender itself, through biological and sociocultural differences, represents a risk factor for early in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI). The aim of our study was to identify the angiographic particularities in women with STEMI from North East Romania.
Material and Methods: For one year, 207 (31.7%) women and 445 (68.3%) men diagnosed with acute myocardial infarction were hospitalized in the Cardiology Clinic of the “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases in Iași, Romania.
Results: The highest incidence of symptom onset was between 6:00 a.m. and 12:00 a.m., this morning polarization being more obvious in women. Within the first two hours of admission to the hospital, coronary angiography was performed in 78.1% of men and only 67.3% of women, the difference being statistically significant (p <0.05). We found that a large number of women had multivascular coronary disease (47.9% vs. 42.3%). At the same time, we found that left main disease and multivascular disease were more frequent in women than in men (3.8% vs. 0.7%, p = 0.001 for left main plus two-vessel disease, and 19.4% vs. 14.8%, p = 0.0005 for three-vessel disease).
Conclusions: In women, coronary events began more frequently in the morning, with atypical symptoms; also, fewer women presented to the hospital within the first 12 hours after the onset of the acute event. Compared to men, women from North East Romania present a higher incidence of multivascular atherosclerotic coronary lessions, indicating a higher severity of STEMI in the female population from this geographical area.
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Guo Y, Yin F, Fan C, Wang Z. Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11644. [PMID: 30045311 PMCID: PMC6078653 DOI: 10.1097/md.0000000000011644] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous researches have reported the controversial results regarding the gender difference in clinical outcomes of patients with coronary artery disease after percutaneous coronary intervention. Hence, this systematic review and meta-analysis was designed to investigate whether gender difference existed in patients with coronary artery disease after percutaneous coronary intervention. METHODS PubMed, Embase, and the Cochrane Library database were searched up to February 10, 2018. Studies comparing the gender-specific effect on clinical outcomes of patients with coronary artery disease after percutaneous coronary intervention were identified, to analyze mortality, major adverse cardiovascular events (MACE) and revascularization. Statistical software RevMan was utilized in this meta-analysis. RESULTS A total of 49 studies, involving 1,032,828 patients (774,115 males and 258,713 females) reporting gender-specific outcomes, were included in this study. The in-hospital mortality, 30-day mortality, 1-year mortality, and at least 2-years mortality in male patients with coronary artery disease after percutaneous coronary intervention were significantly lower than those of females (odds ratio [OR] 0.58 95% confidence interval [CI] 0.52-0.63, P < .001; OR 0.64, 95% CI 0.61-0.66, P = .04; OR 0.67, 95% CI 0.60-0.75, P < .001 and OR 0.71, 95% CI 0.63-0.79, P = .005, respectively). The MACE was significantly decreased in male subjects after initial percutaneous coronary intervention compared with females in <1-year or at least 1-year (OR 0.67, 95% CI 0.56-0.80, P < .001 and OR 0.84, 95% CI 0.76-0.93, P < .001). The male patients after percutaneous coronary intervention harbored higher rate of revascularization compared with females for at least 1-year (OR 1.17, 95% CI 1.00-1.36, P < .001), while the rate of revascularization in male patients for < 1-year was lower than that of females (OR 0.93, 95% CI 0.69-1.26, P < .001). CONCLUSIONS The systematic review and meta-analysis suggests that the prognosis of male patients with coronary artery disease after percutaneous coronary intervention is better than that of females, except for long-term revascularization.
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Affiliation(s)
- Yaya Guo
- The First Medical Clinical College of Lanzhou University
| | - Fahui Yin
- The First Medical Clinical College of Lanzhou University
| | - Chunlei Fan
- The First Medical Clinical College of Lanzhou University
| | - Zhilu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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26
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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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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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28
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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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29
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Langabeer JR, Henry TD, Fowler R, Champagne-Langabeer T, Kim J, Jacobs AK. Sex-Based Differences in Discharge Disposition and Outcomes for ST-Segment Elevation Myocardial Infarction Patients Within a Regional Network. J Womens Health (Larchmt) 2018; 27:1001-1006. [PMID: 29319393 DOI: 10.1089/jwh.2017.6553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND It is known that women with ST-segment elevation myocardial infarction (STEMI) have higher mortality in comparison to men. While the reasons for this sex-based difference are not completely understood, biologic differences and disparities in care have been implicated. Whether these differences persist within an urban, regional STEMI system of care with defined protocols is unclear. Our objective was to explore sex-related effects in outcomes in a large regional system of care. MATERIALS AND METHODS Data were drawn from a regional subset of the National Cardiovascular Data Registry for 33 hospitals in and around Dallas County, Texas from 2010 to 2015. We explored adjusted differences between women and men for discharge disposition, door to balloon (D2B), total ischemic time (TIS), length of stay, and in-hospital mortality rates. RESULTS Multivariate regressions to control for confounding factors, including age, D2B, and TIS, were significantly prolonged in women compared to men (D2B 58 vs. 54 minutes; TIS 206 vs. 178 minutes; both p < 0.001). Length of stay was 0.45 median days longer. Women were also much less likely to survive at discharge than men [odds ratio (OR): 0.63; 95% confidence interval (CI): 0.52-0.76]. Most notably, they were much less likely to be discharged to home than men (88% vs. 92%, p < 0.001). CONCLUSIONS In this study, we found that sex-based disparities persist for both cardiovascular outcomes and discharge disposition, even in a modern regionalized system of care.
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Affiliation(s)
- James R Langabeer
- 1 School of Biomedical Informatics, University of Texas Health Science Center , Houston, Texas
| | | | - Raymond Fowler
- 3 Department of Emergency Medicine, University of Texas Southwestern Medical Center , Dallas, Texas
| | | | - Junghyun Kim
- 1 School of Biomedical Informatics, University of Texas Health Science Center , Houston, Texas
| | - Alice K Jacobs
- 4 Department of Cardiology, Boston Medical Center, Boston University School of Medicine , Boston, Massachusetts
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Wang R, Mei B, Liao X, Lu X, Yan L, Lin M, Zhong Y, Chen Y, You T. Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:243. [PMID: 28899364 PMCID: PMC5596504 DOI: 10.1186/s12872-017-0660-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model. METHODS A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed. RESULTS We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors. CONCLUSION We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.
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Affiliation(s)
- Rui Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Biqi Mei
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xinlong Liao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xia Lu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Lulu Yan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Man Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yao Zhong
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
| | - Tianhui You
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
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31
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Kanic V, Vollrath M, Tapajner A, Sinkovic A. Sex-Related 30-Day and Long-Term Mortality in Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention. J Womens Health (Larchmt) 2017; 26:374-379. [DOI: 10.1089/jwh.2016.5957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Vojko Kanic
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Alojz Tapajner
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andreja Sinkovic
- Department of Cardiology and Angiology, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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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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Manzo-Silberman S. [ST segment elevation myocardial infarction in women]. Ann Cardiol Angeiol (Paris) 2016; 65:385-389. [PMID: 27823676 DOI: 10.1016/j.ancard.2016.10.018] [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] [Indexed: 06/06/2023]
Abstract
In France, coronary disease is responsible for 11.9 deaths/100,000 women aged 35 to 74 years old every year. In France, the number of hospitalizations and deaths for myocardial infarction (MI) increases more significantly in women, particularly under 65. To date, women with MI were 5-10 years older than men, with more risk factors and comorbidities, especially regarding diabetes, high blood pressure and lipid profile. However, a recent comparative study of the FAST-MI registry notes a change in the characteristics of these patients with more and more young women, active smoking and obesity. Their symptoms include more often atypics ones. They also have the particularity of a higher frequency of MI without obstructive lesion. Though, even at the same age, women have a worse prognosis with significantly higher mortality rate, especially early, in-hospital, than those of men. However, there are means to implement in order to reduce complications rate and improve the prognosis through information campaign and primary prevention screening and appropriate care and correction of risk factors. It is also important to raise awareness of general population and care actors about women MI risk even young, about its atypical forms and the necessity of to rapid and aggressive care processes. A better understanding of specific pathophysiological mechanisms appears mandatory and should be supported by prospective dedicated studies.
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Affiliation(s)
- S Manzo-Silberman
- Département de cardiologie, université Paris VII, Inserm UMRS 942, CHU Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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Tan YC, Sinclair H, Ghoorah K, Teoh X, Mehran R, Kunadian V. Gender differences in outcomes in patients with acute coronary syndrome in the current era: A review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:51-60. [PMID: 26450783 DOI: 10.1177/2048872615610886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Coronary heart disease is the most common cause of death worldwide. In the United Kingdom in 2010, over 80,000 deaths were attributed to coronary heart disease, and one in 10 female deaths were due to coronary heart disease. Acute coronary syndrome, a subset of coronary heart disease, was responsible for 175,000 inpatient admissions in the United Kingdom in 2012. While men have traditionally been considered to be at higher risk of acute coronary syndrome, various studies have demonstrated that women often suffer from poorer outcomes following an adverse cardiovascular event. This gap is gradually narrowing with the introduction of advanced interventional strategies and pharmacotherapy. However, a better understanding of these differences is of crucial importance for the improvement of the pharmacological and interventional management of acute coronary syndrome and for the development of possible new gender-specific diagnostic and therapeutic options. The goals of this review are to evaluate gender differences in outcomes in patients with acute coronary syndrome in the current era and identify potential mechanisms behind these differences in outcomes following percutaneous coronary intervention.
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Affiliation(s)
- Ying C Tan
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK
| | - Hannah Sinclair
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.,2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Kuldeepa Ghoorah
- 2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Xuyan Teoh
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK
| | | | - Vijay Kunadian
- 1 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, UK.,2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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35
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Badimon L, Cubedo J. Risk factors' management to impact on acute coronary syndromes. Int J Cardiol 2016; 217 Suppl:S7-9. [PMID: 27378658 DOI: 10.1016/j.ijcard.2016.06.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/25/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Lina Badimon
- Cardiovascular Research Center (CSIC-ICCC) and Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, c/Sant Antoni MªClaret 167, 08025 Barcelona, Spain; Cardiovascular Research Chair UAB, c/Sant Antoni MªClaret 167, 08025 Barcelona, Spain.
| | - Judit Cubedo
- Cardiovascular Research Center (CSIC-ICCC) and Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, c/Sant Antoni MªClaret 167, 08025 Barcelona, Spain
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Conrotto F, D'Ascenzo F, Humphries KH, Webb JG, Scacciatella P, Grasso C, D'Amico M, Biondi-Zoccai G, Gaita F, Marra S. A meta-analysis of sex-related differences in outcomes after primary percutaneous intervention for ST-segment elevation myocardial infarction. J Interv Cardiol 2016; 28:132-40. [PMID: 25884896 DOI: 10.1111/joic.12195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/20/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The increasing use of primary percutaneous coronary intervention (pPCI) has improved clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients, but the impact of sex on early and mid-term outcomes remains to be defined. METHODS Medline, Cochrane Library, Biomed Central, and Google Scholar were searched for articles describing differences in baseline, periprocedural, and midterm outcomes after pPCI, by sex. The primary end point was all-cause mortality at early and mid-term follow-up. Secondary endpoints included in-hospital bleeding and stroke. RESULTS Sixteen studies were included. Women were older, had more frequent hypertension, diabetes mellitus, and hypercholesterolemia, as well as longer ischemia time and more shock at presentation. Men were more likely to have had a previous myocardial infarction. Female sex emerged as independently associated to early mortality (OR 1.1; 95%CI, 1.02-1.18) but not to mid-term mortality (OR, 1.01; 95%CI, 0.99-1.03). The pooled analysis showed a significantly higher risk of in hospital stroke (OR, 1.69; 95%CI, 1.11-2.56) and major bleeding (OR, 2.04; 95%CI, 1.51-2.77) in women. CONCLUSIONS As compared to men, women undergoing pPCI have more bleedings and strokes, and a worse early, but not mid-term mortality. These findings may allow a better risk stratification of pPCI patients.
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Affiliation(s)
- Federico Conrotto
- Department of Cardiology, Città, Della Salute e della Scienza Hospital, Turin, Italy
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Kanic V, Vollrath M, Naji FH, Sinkovic A. Gender Related Survival Differences in ST-Elevation Myocardial Infarction Patients Treated with Primary PCI. Int J Med Sci 2016; 13:440-4. [PMID: 27279793 PMCID: PMC4893558 DOI: 10.7150/ijms.15214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data about gender as an independent risk factor for death in ST-elevation myocardial infarction (STEMI) patients is still contrasting. Aim was to assess how gender influences in-hospital and long-term all-cause mortality in STEMI patients with primary percutaneous coronary intervention (PCI) in our region. METHODS We analysed data from 2069 STEMI patients undergoing primary PCI in our institution from January 2009-December 2014, of whom 28.9% were women. In-hospital and long-term mortality were observed in women and men. The effect of gender on in-hospital mortality was assessed by binary logistic regression modelling and by Cox regression analysis for long-term mortality. RESULTS Women were older (68.3±61.8 vs 61.8±12.0 years; p<0.0001), with a higher prevalence of diabetes (13.7% vs 9.9%; p=0.013) and tend to be more frequently admitted in cardiogenic shock (8.4% vs 6.3%; p =0.085). They were less frequently treated with bivalirudin (15.9% vs 20.3%; p=0.022). In-hospital mortality was higher among women (14.2% vs 7.8%; p<0.0001). After adjustment, age (adjusted OR: 1.05; 95% CI: 1.03 to 1.08; p < 0.001) and cardiogenic shock at admission (adjusted OR: 24.56; 95% CI: 11.98 to 50.35; p < 0.001), but not sex (adjusted OR: 1.47; 95% CI: 0.80 to 2.71) were identified as prognostic factors of in-hospital mortality. During the median follow-up of 27 months (25th, 75th percentile: 9, 48) the mortality rate (23.6% vs 15.1%; p<0.0001) was significantly higher in women. The multivariate adjusted Cox regression model identified age (HR 1.05; 95% CI 1.04-1.07; p<0.0001), cardiogenic shock at admission (HR 6.09; 95% CI 3.78-9.81; p<0.0001), hypertension (HR 1.49; 95% CI 1.02-2.18; p<0.046), but not sex (HR 1.04; 95% CI 0.74-1.47) as independent prognostic factors of follow-up mortality. CONCLUSION Older age and worse clinical presentation rather than gender may explain the higher mortality rate in women with STEMI undergoing primary PCI.
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Affiliation(s)
- Vojko Kanic
- 1. University Medical Centre Maribor, Maribor, Slovenia
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Ghauharali-Imami S, Bax M, Haasdijk A, Schotborgh C, Oemrawsingh P, Bech J, van Domburg R, Zijlstra F. The impact of gender on long-term mortality in patients with multivessel disease after primary percutaneous coronary intervention. Neth Heart J 2015; 23:592-9. [PMID: 26449240 PMCID: PMC4651967 DOI: 10.1007/s12471-015-0754-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Gender and complete revascularisation are known to affect mortality. The objective of this study was to analyse a gender difference in mortality with respect to complete revascularisation for multivessel disease after primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) patients. Method In a prospective consecutive cohort of 1472 patients presenting with STEMI for PPCI, between January 2006 and January 2010, 832 patients with multivessel disease were analysed. The primary outcome was long-term mortality. Results Median follow-up was 3.3 ± 1.2 years. Complete revascularisation was performed less in females than in males (30 vs. 38 %; p = 0.04). At PPCI, women (27 %, n = 221) were ± 10 years older (p = 0.001), had more hypertension, renal failure and symptoms of heart failure (all p < 0.01). Cumulative long-term mortality with incomplete revascularisation was higher in females (F: 30 vs. M: 15 %, p = 0.01). After adjustment for baseline characteristics, complete revascularisation (0.84; 95 % CI 0.54–1.32) and gender (1.11; 95 % CI 0.73–1.69) lost significance. Also the gender-by-complete revascularisation interaction was not significant at long term. In women, age under 60 years independently predicted higher mortality (HR 10.09; 95 % CI 3.08–33.08; p < 0.001). Conclusion In STEMI patients with multivessel disease at PPCI, women under the age of 60 years had higher mortality, but in women older than 60 years comorbidity impacted the outcome of revascularisation strategy in the long term.
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Affiliation(s)
- S Ghauharali-Imami
- Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands.
| | - M Bax
- Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - A Haasdijk
- Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - C Schotborgh
- Haga-Teaching Hospital, HagaZiekenhuis, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - P Oemrawsingh
- Medical Centre Haaglanden, The Hague, The Netherlands
| | - J Bech
- Reinier de Graaf Gasthuis, Delft, The Netherlands
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Short and long-term mortality in women and men undergoing primary angioplasty: A comprehensive meta-analysis. Int J Cardiol 2015; 198:123-30. [DOI: 10.1016/j.ijcard.2015.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/22/2015] [Accepted: 07/01/2015] [Indexed: 01/15/2023]
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40
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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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Solinas E, Vignali L, Ortolani P, Guastaroba P, Marzocchi A, Manari A, De Palma R, Mehran R, Paoli G, Notarangelo MF, Caminiti C, Ardissino D, Merlini PA. Association of bleeding, mortality and sex in acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2015; 16:347-54. [DOI: 10.2459/jcm.0000000000000174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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van Loo HM, van den Heuvel ER, Schoevers RA, Anselmino M, Carney RM, Denollet J, Doyle F, Freedland KE, Grace SL, Hosseini SH, Parakh K, Pilote L, Rafanelli C, Roest AM, Sato H, Steeds RP, Kessler RC, de Jonge P. Sex dependent risk factors for mortality after myocardial infarction: individual patient data meta-analysis. BMC Med 2014; 12:242. [PMID: 25515680 PMCID: PMC4292997 DOI: 10.1186/s12916-014-0242-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/21/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although a number of risk factors are known to predict mortality within the first years after myocardial infarction, little is known about interactions between risk factors, whereas these could contribute to accurate differentiation of patients with higher and lower risk for mortality. This study explored the effect of interactions of risk factors on all-cause mortality in patients with myocardial infarction based on individual patient data meta-analysis. METHODS Prospective data for 10,512 patients hospitalized for myocardial infarction were derived from 16 observational studies (MINDMAPS). Baseline measures included a broad set of risk factors for mortality such as age, sex, heart failure, diabetes, depression, and smoking. All two-way and three-way interactions of these risk factors were included in Lasso regression analyses to predict time-to-event related all-cause mortality. The effect of selected interactions was investigated with multilevel Cox regression models. RESULTS Lasso regression selected five two-way interactions, of which four included sex. The addition of these interactions to multilevel Cox models suggested differential risk patterns for males and females. Younger women (age<50) had a higher risk for all-cause mortality than men in the same age group (HR 0.7 vs. 0.4), while men had a higher risk than women if they had depression (HR 1.4 vs. 1.1) or a low left ventricular ejection fraction (HR 1.7 vs. 1.3). Predictive accuracy of the Cox model was better for men than for women (area under the curves: 0.770 vs. 0.754). CONCLUSIONS Interactions of well-known risk factors for all-cause mortality after myocardial infarction suggested important sex differences. This study gives rise to a further exploration of prediction models to improve risk assessment for men and women after myocardial infarction.
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Affiliation(s)
- Hanna M van Loo
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Den Dolech 2, 5612 AZ, Eindhoven, The Netherlands.
| | - Robert A Schoevers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, C.so A.M. Dogliotti, 14, 10126, Turin, Italy.
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, St. Louis, Missouri, 63108, USA.
| | - Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Warandelaan 2, 5000 LE, Tilburg, The Netherlands.
| | - Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, St. Louis, Missouri, 63108, USA.
| | - Sherry L Grace
- Faculty of Health, York University and University Health Network, 368 Norman Bethune, 4700 Keele Street, Toronto, M3J 1P3, Canada.
| | - Seyed H Hosseini
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Psychosomatic department, Imam hospital, Sari, Iran.
| | - Kapil Parakh
- John Hopkins School of Medicine, John Hopkins Bloomberg School of Public Health, John Hoplins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, Maryland, 21224, USA.
| | - Louise Pilote
- Division of General Internal Medicine, McGill University, McGill University Health Centre, 687 Pine Avenue West, V Building, V2.17, Montreal, H3A 1A1, Canada.
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Annelieke M Roest
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Hiroshi Sato
- School of Human Welfare Studies, Kwansei Gakuin University, 1-1-155, Uegahara, Nishinomiya, Hyogo, 662-8501, Japan.
| | - Richard P Steeds
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, West Midlands, UK.
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, 02115, USA.
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB, Groningen, The Netherlands.
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Fengler K, Fuernau G, Desch S, Eitel I, Neumann FJ, Olbrich HG, de Waha A, de Waha S, Richardt G, Hennersdorf M, Empen K, Hambrecht R, Fuhrmann J, Böhm M, Poess J, Strasser R, Schneider S, Schuler G, Werdan K, Zeymer U, Thiele H. Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol 2014; 104:71-8. [PMID: 25287767 DOI: 10.1007/s00392-014-0767-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/29/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with high mortality. Previous studies regarding gender-specific differences in CS are conflicting and there are insufficient data for the presence of gender-associated differences in the contemporary percutaneous coronary intervention era. Aim of this study was therefore to investigate gender-specific differences in a large cohort of AMI patients with CS undergoing contemporary treatment. METHODS In the randomized Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial, 600 patients with CS complicating AMI undergoing early revascularization were assigned to therapy with or without intra-aortic balloon pump. We compared sex-specific differences in these patients with regard to baseline and procedural characteristics as well as short- and long-term clinical outcome. RESULTS Of 600 patients 187 (31%) were female. Women were significantly older than men and had a significantly lower systolic and diastolic blood pressure at presentation (p < 0.05 for all). Diabetes mellitus and hypertension were more frequent in women, whereas smoking was more frequent in men (p < 0.05 for all). Women showed a higher mortality within the first day after randomization (p = 0.004). However, after multivariable adjustment this numerical difference was no longer statistically significant. No gender-related differences in clinical outcome were observed after 1, 6 and 12 months of follow-up. CONCLUSION In this large-scale multicenter study in patients with CS complicating AMI, women had a worse-risk profile in comparison to men. No significant gender-related differences in treatment as well as short- and long-term outcome were observed.
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Affiliation(s)
- Karl Fengler
- Department of Internal Medicine, Cardiology, University of Leipzig, Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany
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Outcome after ST elevation myocardial infarction in patients with cancer treated with primary percutaneous coronary intervention. Am J Cardiol 2013; 112:1867-72. [PMID: 24063839 DOI: 10.1016/j.amjcard.2013.08.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 11/21/2022]
Abstract
The simultaneous occurrence of cancer and coronary heart disease is increasing in the Western world. Nevertheless, the influence of cancer on ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has not been investigated extensively. This multicenter registry included patients with STEMI treated with primary PCI from 2006 to 2009. Patients were stratified according to history of cancer, and primary focus lay on all-cause and cardiac mortalities during 1-year follow-up. Adjusted effect sizes were calculated using Cox proportional hazard models. In total, 208 patients had a history of cancer (diagnosed ≤6 months ago in 20.7%, 6 months to 3 years ago in 21.7%, and >3 years ago in 57.6%) and 3,215 patients had no history of cancer. Chemotherapy had been administered previously to 23% of patients with cancer. Patients with cancer were older, more frequently women, and more commonly known with previous myocardial infarction or anemia. Reperfusion rates were similar after PCI. Patients with cancer showed greater all-cause (17.4% vs 6.5% in other patients) and cardiac mortalities at 1 year (10.7% vs 5.4% in other patients) because of high early cardiac death (23.8%) in recently diagnosed patients with cancer. After adjustment, a recent cancer diagnosis predicted cardiac mortality at 7 days (hazard ratio 3.34, 95% confidence interval 1.57 to 7.08). The adverse prognosis was partly explained by anemia and occurrence of cardiogenic shock, whereas outcome was independent of cancer treatment. In conclusion, patients with cancer showed greater mortality after STEMI. A cancer diagnosis in the 6 months before primary PCI was strongly associated with early cardiac mortality.
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In-hospital major bleeding and its clinical relevance in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2013; 112:1533-9. [PMID: 23953696 DOI: 10.1016/j.amjcard.2013.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 12/16/2022]
Abstract
Advances in antithrombotic therapy for ST elevation myocardial infarction (STEMI) enhance the risk of bleeding. Therefore, the incidence, determinants, and prognostic implications of in-hospital major bleeding after primary percutaneous coronary intervention for STEMI were investigated. In 963 consecutive patients, the incidence of bleeding was evaluated according to commonly used classifications including Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines, Thrombolysis In Myocardial Infarction, Global Use of Strategies To Open coronary arteries, and Bleeding Academic Research Consortium. Multivariate regression analyses investigated determinants of bleeding and the relation between bleeding and 1-year all-cause mortality. Large variability in incidence existed depending on classification (1.3% to 21%). Female gender, heart rate, creatinine, multivessel disease, cardiogenic shock, and procedural failure were independently associated with bleeding. One-year mortality reached 10.2% in bleeders versus 2.0% in nonbleeders (p <0.001). Bleeding was independently associated with an increased risk of 1-year mortality (hazard ratio [HR] 2.41, p <0.017). Assessment of individual classifications confirmed the increased risk of mortality for Bleeding Academic Research Consortium (HR 2.27, p = 0.048), but not for Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines, Thrombolysis In Myocardial Infarction, and Global Use of Strategies To Open coronary arteries bleeding. Thrombotic events occurred more frequently in bleeders (5.8% vs 1.5%, p <0.001); however, bleeding remained independently related to mortality with a negligible reduction in HR (2.25, p = 0.028) after adjustment. In conclusion, in-hospital major bleeding was frequently observed after STEMI, but a widespread variation in incidence existed depending on the applied definition. Patient and procedural characteristics were related to bleeding, allowing identification of high-risk patients. In-hospital major bleeding was independently associated with 1-year all-cause mortality; however, not all bleeding classifications proved equally relevant to prognosis. The relation between bleeding and mortality was shown not to be driven by the higher rate of thrombotic events among bleeders.
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Velders MA, van Boven N, Boden H, van der Hoeven BL, Heestermans AACM, Jukema JW, de Jonge E, Kuiper MA, van Boven AJ, Hofma SH, Schalij MJ, Umans VAWM. Association between angiographic culprit lesion and out-of-hospital cardiac arrest in ST-elevation myocardial infarction patients. Resuscitation 2013; 84:1530-5. [PMID: 23907098 DOI: 10.1016/j.resuscitation.2013.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/01/2013] [Accepted: 07/19/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Factors related to the occurrence of out-of-hospital cardiac arrest (OHCA) in ST-elevation myocardial infarction (STEMI) are still poorly understood. The current study sought to compare STEMI patients presenting with and without OHCA to identify angiographic factors related to OHCA. METHODS This multicenter registry consisted of consecutive STEMI patients, including OHCA patients with return-of-spontaneous circulation. Patients were treated with primary percutaneous coronary intervention (PCI) and therapeutic hypothermia when indicated. Outcome consisted of in-hospital neurological recovery, scored using the Cerebral Performance Categories (CPC) scale, and 1-year survival. Logistic regression was used to identify factors associated with OHCA and survival was displayed with Kaplan-Meier curves and compared using log rank tests. RESULTS In total, 224 patients presented with OHCA and 3259 without OHCA. Average age was 63.3 years and 75% of patients were male. OHCA occurred prior to ambulance arrival in 68% of patients and 48% required intubation. Culprit lesion was associated with OHCA: risk was highest for proximal left coronary lesions and lowest for right coronary lesions. Also, culprit lesion determined the risk of cardiogenic shock and sub-optimal reperfusion after PCI, which were strongly related to survival after OHCA. Neurological recovery was acceptable (CPC≤2) in 77.1% of OHCA patients and did not differ between culprit lesions. CONCLUSIONS In the present STEMI population, coronary culprit lesion was associated with the occurrence of OHCA. Moreover, culprit lesion influenced the risk of cardiogenic shock and success of reperfusion, both of which were related to prognosis of OHCA patients.
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Affiliation(s)
- M A Velders
- Leiden University Medical Center, Leiden, The Netherlands; Medical Center Leeuwarden, Leeuwarden, The Netherlands.
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Rademaker AAEM, Danad I, Groothuis JGJ, Heymans MW, Marcu CB, Knaapen P, Appelman YEA. Comparison of different cardiac risk scores for coronary artery disease in symptomatic women: do female-specific risk factors matter? Eur J Prev Cardiol 2013; 21:1443-50. [PMID: 23804558 DOI: 10.1177/2047487313494571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular diseases remain the leading cause of death in women and there is a need for more accurate risk assessment scores. The aims of our study were to compare the accuracy of several widely used cardiac risk assessment scores in predicting the likelihood of obstructive coronary artery disease (CAD) on CT coronary angiography (CTCA) in symptomatic women and to explore which female-specific risk factors were independent predictors of obstructive CAD on CTCA and whether adding these risk factors to pre-test probability scores would improve their predictive value. METHODS AND RESULTS Data were obtained from a cohort of 228 consecutively included symptomatic women undergoing evaluation for CAD and referred for CTCA. Obstructive CAD was defined as ≥50% luminal stenosis on CTCA. Pre-test probability for CAD was calculated according to the Diamond and Forrester score, New score, Duke clinical score, and an updated Diamond and Forrester score. Female-specific factors were obtained by a written questionnaire. Pre-test probability scores were compared with ROC analysis and showed that only the New score and the updated Diamond and Forrester score were significant predictive scores for obstructive CAD on CTCA (area under the curve, AUC, 0.67, p < 0.01; AUC 0.61, p = 0.04, respectively). Multivariable logistic regression analysis identified that gestational diabetes mellitus (GDM) and oestrogen status were independent predictors of obstructive CAD when adjusted for the pre-test probability scores. The updated Diamond and Forrester score was used for net reclassification improvement (NRI) analysis, since the New score already accounts for oestrogen status. Adding GDM and oestrogen status to the updated Diamond and Forrester score resulted in a significant NRI (p = 0.04). CONCLUSIONS There is a large variability in prediction of obstructive CAD using different pre-test probability risk scores in symptomatic women. Logistic regression analysis revealed that oestrogen status and GDM were independently associated with the occurrence of obstructive stenosis on CTCA. The predictive ability of cardiac pre-test probability scores improved significantly with the addition of oestrogen status and GDM.
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Affiliation(s)
| | - Ibrahim Danad
- VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Paul Knaapen
- VU University Medical Center, Amsterdam, The Netherlands
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