1
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Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024; 13:e033515. [PMID: 38842272 PMCID: PMC11255752 DOI: 10.1161/jaha.123.033515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
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Affiliation(s)
| | - Irisha Badu
- Department of MedicineOnslow Memorial HospitalJacksonvilleNC
| | - Sanchit Duhan
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | | | | | - Amro Taha
- Department of MedicineWeiss Memorial HospitalChicagoIL
| | | | - Yasar Sattar
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Bijeta Keisham
- Department of MedicineSinai Hospital of BaltimoreBaltimoreMD
| | - Shafaqat Ali
- Department of Internal MedicineLouisiana State UniversityShreveportLA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of MedicineBridgetownBarbados
| | - Minahil Naeem
- Department of Internal MedicineKing Edward Medical UniversityLahorePakistan
| | - Ayesha Shaik
- Department of CardiologyHartford HospitalHartfordCT
| | - Sudarshan Balla
- Department of CardiologyWest Virginia UniversityMorgantownWV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart CenterSmidt Heart Institute, Cedars Sinai Medical CenterLos AngelesCA
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2
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Jung C. [ECLS shock study-no advantage for venoarterial ECMO in cardiogenic shock]. Med Klin Intensivmed Notfmed 2024; 119:46-48. [PMID: 37747480 DOI: 10.1007/s00063-023-01070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie des Universitätsklinikums Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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3
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Hannan EL, Wu Y, Harik L, Tamis-Holland J, Jacobs AK, Chikwe J, Cozzens KS, Gaudino M. Coronary artery bypass surgery versus percutaneous interventions for women with multivessel coronary artery disease. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01196-0. [PMID: 38101766 DOI: 10.1016/j.jtcvs.2023.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To compare outcomes in women undergoing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. DESIGN This retrospective, propensity-score matched cohort study from the New York State cardiac registry (2012-2018) included all women with multivessel coronary artery disease undergoing PCI with everolimus-eluting stents (EES) and CABG surgery. The primary outcome was all-cause mortality. The key secondary outcome was major adverse cardiac events, defined as the composite of all-cause mortality, myocardial infarction, and stroke. RESULTS PCI with EES was associated with a higher 6-year risk of mortality (25.75% vs 23.57%; adjusted hazard ratio [AHR], 1.29; 95% confidence interval [CI], 1.14-1.45). PCI also was associated with a higher rate of the composite outcome of death, myocardial infarction, and stroke (36.58% vs 32.89%; AHR, 1.28; 95% CI, 1.17-1.41), as well as myocardial infarction (14.94% vs 9.12%; AHR, 1.84; 95% CI, 1.56-2.17), but not stroke (7.07% vs 7.62%; AHR, 0.83; 95% CI, 0.67-1.03). Repeat revascularization rates also were higher for women undergoing PCI (21.53% vs 11.57%; AHR, 1.88; 95% CI, 1.63-2.17). There was no difference in mortality between the 2 interventions when PCI patients received complete revascularization or had noncomplex lesions and for women without diabetes. CONCLUSIONS For women with multivessel coronary artery disease, CABG surgery is associated with lower 6-year mortality, myocardial infarction, and repeat revascularization rates compared to PCI with EES.
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Affiliation(s)
- Edward L Hannan
- University at Albany, State University of New York, Albany, NY
| | - Yifeng Wu
- University at Albany, State University of New York, Albany, NY
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Jacqueline Tamis-Holland
- Cardiovascular Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alice K Jacobs
- Department of Medicine, Boston Medical Center, Boston, Mass
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
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4
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Theofilis P, Vlachakis PK, Mantzouranis E, Sakalidis A, Chrysohoou C, Leontsinis I, Lazaros G, Dimitriadis K, Drakopoulou M, Vordoni A, Oikonomou E, Tsioufis K, Tousoulis D. Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics. Angiology 2023:33197231218331. [PMID: 37995282 DOI: 10.1177/00033197231218331] [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] [Indexed: 11/25/2023]
Abstract
Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis K Vlachakis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Mantzouranis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Sakalidis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Leontsinis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Drakopoulou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Vordoni
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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5
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Joodi G, Palimar S, Press MC. Percutaneous Coronary Interventions in Women. Curr Atheroscler Rep 2023; 25:829-837. [PMID: 37815649 PMCID: PMC10618306 DOI: 10.1007/s11883-023-01150-x] [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] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
PURPOSEOF REVIEW Cardiovascular disease is the leading cause of morbidity and mortality among women globally. Numerous studies show ongoing disparities in diagnosis, management, and outcomes of ischemic heart disease in women compared to men. We aim to review the factors contributing to sex-based differential outcomes of percutaneous coronary interventions in women. RECENT FINDINGS Hormonal influence on coronary arteries and progression of atherosclerosis in women results in distinct coronary plaque characteristics and unique pathological process such as spontaneous coronary artery dissection and myocardial infarction with non-obstructive coronary arteries. During the presentation of acute coronary syndromes, women are older and have higher burden of comorbidities, with higher short- and long-term mortality. Awareness of differences in vascular biology and unique risk factors for cardiovascular disease in women is essential for sustained improvement in cardiovascular mortality. Better representation of women in trials is crucial to address the gaps in knowledge and allow for individualized treatment approaches in women.
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Affiliation(s)
- Golsa Joodi
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sristi Palimar
- Institute for Society and Genetics, UCLA, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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6
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Holtzman JN, Kaur G, Hansen B, Bushana N, Gulati M. Sex differences in the management of atherosclerotic cardiovascular disease. Atherosclerosis 2023; 384:117268. [PMID: 37723005 DOI: 10.1016/j.atherosclerosis.2023.117268] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/23/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
Disparities between women and men persist in the diagnosis, treatment, and prognosis of atherosclerotic cardiovascular disease (ASCVD). Despite growing attention to sex-based differences in cardiovascular care, there are continued disparities in short- and long-term outcomes. Such disparities highlight the need to identify pathophysiologic differences in treatment patterns for stable ischemic heart disease, non-ST elevation myocardial infarction (NSTE-ACS), ST-elevation myocardial infarction (STEMI), and myocardial infarction with non-obstructive coronary arteries (MINOCA). The role of age as an effect modifier should also be considered given that young women diagnosed with ACS continue to experience increased rates of in-hospital mortality and major adverse cardiovascular events. Both patient-directed and systems-based approaches remain integral to improve outcomes in cardiovascular care. While inadequate representation of women in clinical trials remains a barrier to the implementation of evidence-based therapies, a growing body of data has established the efficacy and safety of medications in women across acute coronary syndromes. This review seeks to feature existing data on the differential treatment guidelines, care implementation, and cardiovascular outcomes between women and men, highlighting next directions for clinical investigation.
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Affiliation(s)
- Jessica N Holtzman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Breanna Hansen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Martha Gulati
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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7
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Rao P, Sabe M. Revisiting VA-ECMO in infarct-related cardiogenic shock. Lancet 2023; 402:1302-1303. [PMID: 37643629 DOI: 10.1016/s0140-6736(23)01688-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA.
| | - Marwa Sabe
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
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8
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Savage ML, Hay K, Vollbon W, Doan T, Murdoch DJ, Hammett C, Poulter R, Walters DL, Denman R, Ranasinghe I, Raffel OC. Prehospital Activation of the Cardiac Catheterization Laboratory in ST-Segment-Elevation Myocardial Infarction for Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2023:e029346. [PMID: 37449585 PMCID: PMC10382081 DOI: 10.1161/jaha.122.029346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Background Prehospital activation of the cardiac catheter laboratory is associated with significant improvements in ST-segment-elevation myocardial infarction (STEMI) performance measures. However, there are equivocal data, particularly within Australia, regarding its influence on mortality. We assessed the association of prehospital activation on performance measures and mortality in patients with STEMI treated with primary percutaneous coronary intervention from the Queensland Cardiac Outcomes Registry (QCOR). Methods and Results Consecutive ambulance-transported patients with STEMI treated with primary percutaneous coronary intervention were analyzed from January 1, 2017 to December 31, 2020 from the QCOR. The total and direct effects of prehospital activation on the primary outcomes (30-day and 1-year cardiovascular mortality) were estimated using logistic regression analyses. Secondary outcomes were STEMI performance measures. Among 2498 patients (mean age: 62.2±12.4 years; 79.2% male), 73% underwent prehospital activation. Median door-to-balloon time (34 minutes [26-46] versus 86 minutes [68-113]; P<0.001), first-electrocardiograph-to-balloon time (83.5 minutes [72-98] versus 109 minutes [81-139]; P<0.001), and proportion of patients meeting STEMI targets (door-to-balloon <60 minutes 90% versus 16%; P<0.001), electrocardiograph-to-balloon time <90 minutes (62% versus 33%; P<0.001) were significantly improved with prehospital activation. Prehospital activation was associated with significantly lower 30-day (1.6% versus 6.6%; P<0.001) and 1-year cardiovascular mortality (2.9% versus 9.5%; P<0.001). After adjustment, no prehospital activation was strongly associated with increased 30-day (odds ratio [OR], 3.6 [95% CI, 2.2-6.0], P<0.001) and 1-year cardiovascular mortality (OR, 3.0 [95% CI, 2.0-4.6]; P<0.001). Conclusions Prehospital activation of cardiac catheterization laboratory for primary percutaneous coronary intervention was associated with significantly shorter time to reperfusion, achievement of STEMI performance measures, and lower 30-day and 1-year cardiovascular mortality.
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Affiliation(s)
- Michael L Savage
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Karen Hay
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - William Vollbon
- Queensland Cardiac Outcomes Registry Brisbane Queensland Australia
| | - Tan Doan
- Queensland Ambulance Service Brisbane Queensland Australia
| | - Dale J Murdoch
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Christopher Hammett
- Cardiology Department The Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Rohan Poulter
- Queensland Cardiac Outcomes Registry Brisbane Queensland Australia
- Cardiology Department Sunshine Coast University Hospital Brisbane Queensland Australia
| | - Darren L Walters
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Russell Denman
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Isuru Ranasinghe
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Owen Christopher Raffel
- Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia
- School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia
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9
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Varma Y, Jena NK, Arsene C, Patel K, Sule AA, Krishnamoorthy G. Disparities in the management of non-ST-segment elevation myocardial infarction in the United States. Int J Cardiol 2023:S0167-5273(23)00592-2. [PMID: 37137356 DOI: 10.1016/j.ijcard.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
Guidelines recommend managing patients aged ≥75 with non-ST-segment elevation myocardial infarction (NSTEMI) similar to younger patients. We analyze disparities in NSTEMI management and compare those ≥80 years to those <80 years. This is a matched case-control study using the 2016 National Inpatient Sample data of adults with NSTEMI receiving percutaneous coronary intervention with drug-eluting stent (PCI-DES) - one artery or no intervention. We included the statistically significant variables in univariate analysis in exploratory multivariate logistic regression models. Total sample included 156,328 patients, out of which 43,265 were ≥ 80 years, and 113,048 were < 80 years. Patients ≥80 years were more likely to not have an intervention (73.3%) when compared to those <80 (44.1%), P < 0.0005. Regardless of age, PCI-DES-one artery improved survival compared to no intervention (Age < 80: OR 0.230, 95% CI 0.189-0.279, and ≥ 80: OR 0.265, 95% CI 0.195-0.361, P < 0.0005). Women (OR 0.785, 95% CI 0.766-0.804, P < 0.0005) and non-white race (OR 0.832, 95% CI 0.809-0.855, P < 0.0005) were less likely to receive an intervention. Non-Medicare/Medicaid insurance was associated with 40% lower likelihood of dying in <80 age group (OR 0.596, 95% CI 0.491-0.724, P < 0.0005), and 16% higher chance of intervention overall (OR 1.160, 95% CI 1.125-1.197, P < 0.0005). Patients aged ≥80 with NSTEMI were 29% less likely to receive an intervention compared to patients aged <80, even though patients >80 derived similar mortality benefits from the intervention. There were gender, payor, and race-based disparities in NSTEMI management in 2016.
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Affiliation(s)
- Yash Varma
- Department of Internal Medicine, Graduate Medical Education, Trinity Health Oakland Hospital/Wayne State University Program, USA.
| | - Nihar Kanta Jena
- Division of Cardiovascular Medicine, Graduate Medical Education, Trinity Health Oakland Hospital/Wayne State University Program, USA
| | - Camelia Arsene
- Department of Internal Medicine, Graduate Medical Education, Trinity Health Oakland Hospital/Wayne State University Program, USA
| | - Kirit Patel
- Division of Cardiovascular Medicine, Graduate Medical Education, Trinity Health Oakland Hospital/Wayne State University Program, USA
| | - Anupam Ashutosh Sule
- Department of Internal Medicine, Graduate Medical Education, Trinity Health Oakland Hospital/Wayne State University Program, USA
| | - Geetha Krishnamoorthy
- Department of Internal Medicine, Graduate Medical Education, Trinity Health Oakland Hospital/Wayne State University Program, USA
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10
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Burgess SN, Mamas MA. Narrowing disparities in PCI outcomes in women; From risk assessment, to referral pathways and outcomes. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 24:100225. [PMID: 38560635 PMCID: PMC10978432 DOI: 10.1016/j.ahjo.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 04/04/2024]
Abstract
This review evaluates published data regarding outcomes for women with ACS undergoing PCI. Data is discussed from a patient centred perspective and timeline, beginning with sex-based differences in perception of risk, time to presentation, time to treatment, access to angiography, access to angioplasty, the impact of incomplete revascularization, prescribing practices, under-representation of women in randomized controlled trials and in cardiology physician workforces. The objective of the review is to identify factors contributing to outcome disparities for women with ACS, and to discuss potential solutions to close this outcome gap.
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Affiliation(s)
- Sonya N. Burgess
- Department of Cardiology, Nepean Hospital, Sydney, Australia
- University of Sydney, NSW, Australia
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
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11
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Savage M, Hay K, Murdoch D, Walters DL, Denman R, Ranasinghe I, Raffel C. Sex differences in time to primary percutaneous coronary intervention and outcomes in patients presenting with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2022; 100:520-529. [PMID: 35971748 PMCID: PMC9804760 DOI: 10.1002/ccd.30357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We assessed sex differences in treatment and outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). BACKGROUND Historically, delays to timely reperfusion and poorer outcomes have been described in women who suffer STEMI. However, whether these sex discrepancies still exist with contemporary STEMI treatment remains to be evaluated. METHODS Consecutive STEMI patients treated with primary PCI patients over a 10-year period (January 1, 2010 to December 31, 2019) from a tertiary referral center were assessed. Comparisons were performed between patient's sex. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes were STEMI performance measures. RESULTS Most patients (n = 950; 76%) were male. Females were on average older (66.8 vs. 61.4 years males; p < 0.001). Prehospital treatment delays did not differ between sexes (54 min [IQR: 44-65] females vs. 52 min [IQR: 43-62] males; p = 0.061). STEMI performance measures (door-to-balloon, first medical contact-to-balloon [FMCTB]) differed significantly with longer median durations in females and fewer females achieving FMCTB < 90 min (28% females vs. 39% males; p < 0.001). Women also experienced greater rates of initial radial arterial access failure (11.3% vs. 3.1%; p < 0.001). However, there were no significant sex differences in crude or adjusted mortality between sexes at 30-days (3.6% male vs. 5.1% female; p = 0.241, adjusted OR: 1.1, 95% CI: 0.5-2.2, p = 0.82) or at 1-year (4.8% male vs. 6.8% female; p = 0.190, adjusted OR: 1.0, (95% CI: 0.5-1.8; p = 0.96). CONCLUSION Small discrepancies between sexes in measures of timely reperfusion for STEMI still exist. No significant sex differences were observed in either 30-day or 1-year mortality.
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Affiliation(s)
- Michael L. Savage
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Karen Hay
- School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Dale J. Murdoch
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Darren L. Walters
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Russell Denman
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Isuru Ranasinghe
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Christopher Raffel
- Cardiology DepartmentThe Prince Charles HospitalBrisbaneQueenslandAustralia,School of Clinical Medicine, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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12
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Altin SE, Gitto M, Secemsky EA, Rao SV, Hess CN. Sex-Based Differences in Periprocedural Complications Following Lower Extremity Peripheral Vascular Intervention. Circ Cardiovasc Interv 2022; 15:e011768. [PMID: 35938403 DOI: 10.1161/circinterventions.121.011768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women with coronary artery disease are shown to have worse outcomes after percutaneous coronary intervention compared with men; however, less is known about sex-based outcomes following lower extremity peripheral vascular intervention (PVI) for symptomatic peripheral artery disease. The study aims to assess whether female sex is independently associated with periprocedural complications in patients undergoing PVI. METHODS Analysis includes patients undergoing lower extremity PVI from September 2016 to March 2020 from the Vascular Quality Initiative registry. Multivariate logistic regression was used to assess the independent association of female sex with post-PVI complications. RESULTS Of the 119 620 patients included, 47 316 (39.6%) were women. Analysis reflected that women were at higher risk of developing access site complications, including any hematoma (odds ratio [OR], 1.45 [1.35-1.57]), hematoma requiring transfusion (OR, 2.24 [1.82-2.76]; P<0.001), hematoma requiring surgery (OR, 1.49 [1.19-1.86]; P<0.001), pseudoaneurysm (OR, 1.69 [1.39-2.05]; P<0.001), and access site occlusion (OR, 1.89 [1.15-3.08]; P<0.001). Women also faced higher risks of target lesion dissection (OR, 1.36 [1.26-1.46]; P<0.001), above-knee amputation (OR, 1.37 [1.18-1.58]; P<0.001), and in-hospital mortality (OR, 1.21 [1.07-1.38]; P=0.003). CONCLUSIONS In a contemporary cohort, women undergoing lower extremity PVI for symptomatic peripheral artery disease were at higher risk than men of developing periprocedural complications, including moderate or severe access site bleeding, above-knee amputation, and in-hospital mortality. This increased risk persisted despite adjustment for differences in baseline patient or procedural characteristics and warrants further investigation.
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Affiliation(s)
- S Elissa Altin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (S.E.A.)
- West Haven VA Medical Center, CT (S.E.A.)
| | - Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.G.)
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy (M.G.)
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.S.)
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC (S.V.R.)
| | - Connie N Hess
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (C.N.H.)
- CPC Clinical Research, Aurora, CO (C.N.H.)
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13
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Gender specific performance of one- compared to two-catheter concepts in transradial coronary angiography – Insights from the randomized UDDC-Radial-Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:49-54. [DOI: 10.1016/j.carrev.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
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14
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Gaudino M, Di Franco A, Cao D, Giustino G, Bairey Merz CN, Fremes SE, Kirtane AJ, Kunadian V, Lawton JS, Masterson Creber RM, Sandner S, Vogel B, Zwischenberger BA, Dangas GD, Mehran R. Sex-Related Outcomes of Medical, Percutaneous, and Surgical Interventions for Coronary Artery Disease: JACC Focus Seminar 3/7. J Am Coll Cardiol 2022; 79:1407-1425. [PMID: 35393023 DOI: 10.1016/j.jacc.2021.07.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
Biological and sociocultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the 2 sexes. Worse outcomes in women have been described following both conservative and invasive treatments of CAD. For example, increased levels of residual platelet reactivity during treatment with antiplatelet drugs, higher rates of adverse cardiovascular outcomes following percutaneous coronary revascularization, and higher operative and long-term mortality after coronary bypass surgery have been reported in women compared with in men. Despite the growing recognition of sex-specific determinants of outcomes, representation of women in clinical studies remains low and sex-specific management strategies are generally not provided in guidelines. This review summarizes the current evidence on sex-related differences in patients with CAD, focusing on the differential outcomes following medical therapy, percutaneous coronary interventions, and coronary artery bypass surgery.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ajay J Kirtane
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center and the Cardiovascular Research Foundation, New York, New York, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany A Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Gragnano F, Jolly S, Mehta S, Branca M, van Klaveren D, Frigoli E, Gargiulo G, Leonardi S, Vranckx P, Di Maio D, Monda E, Fimiani L, Fioretti V, Chianese S, Andò G, Esposito G, Sangiorgi G, Biondi-Zoccai G, Heg D, Calabrò P, Windecker S, Romagnoli E, Valgimigli M. Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score. EUROINTERVENTION 2021; 17:e971-e980. [PMID: 34374343 PMCID: PMC9724886 DOI: 10.4244/eij-d-21-00441] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover. AIMS We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively. METHODS The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively. RESULTS The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover. CONCLUSIONS The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.
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Affiliation(s)
- Felice Gragnano
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland,Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Sanjit Jolly
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shamir Mehta
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mattia Branca
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | | | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium,Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Dario Di Maio
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Emanuele Monda
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Luigi Fimiani
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Fioretti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Salvatore Chianese
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Mediterranea Cardiocentro, Naples, Italy
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Paolo Calabrò
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland. E-mail:
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16
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Bhardwaj B, Gunzburger E, Valle JA, Grunwald GK, Plomondon ME, Vidovich MI, Aggarwal K, Karuparthi PR. Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program. Catheter Cardiovasc Interv 2021; 99:480-488. [PMID: 34847279 DOI: 10.1002/ccd.30024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/23/2021] [Accepted: 11/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM-PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system. BACKGROUND TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM-PCI remain less studied. METHODS All LM-PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure-related variables were compared by access site. Both short- and long-term clinical outcomes were analyzed using propensity score matching. RESULTS A total of 4004 LM-PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM-PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1-year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding. CONCLUSION Use of TRA for LM-PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1-year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM-PCI.
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Affiliation(s)
- Bhaskar Bhardwaj
- Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Elise Gunzburger
- VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA
| | - Javier A Valle
- VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA
| | - Gary K Grunwald
- VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary E Plomondon
- VA CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia, USA
| | - Mladen I Vidovich
- Section of Cardiology, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Kul Aggarwal
- Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Poorna Raj Karuparthi
- Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.,Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA
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17
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Chaudry HI, Lee J, Li SX, Gasperetti A, Lee KM, Zbib NH, Amakiri IC, Andrus BW, DeVries JT. Sex Differences in Acute Bleeding and Vascular Complications Following Percutaneous Coronary Intervention Between 2003 and 2016: Trends From the Dartmouth Dynamic Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28:32-38. [DOI: 10.1016/j.carrev.2020.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
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18
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Malik AH, Yandrapalli S, Shetty SS, Zaid S, Athar A, Aronow WS, Timmermans RJ, Ahmad H, Cooper HA, Naidu SS, Panza JA. Radial vs. Femoral Access for Percutaneous Coronary Artery Intervention in Patients With ST-Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28:57-64. [PMID: 32981856 DOI: 10.1016/j.carrev.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to compare the safety and efficacy of transradial vs transfemoral access for coronary angiography and intervention in patients presenting with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock. METHODS PubMed, Embase and Cochrane Central were searched for randomized controlled trials (RCTs) comparing outcomes of STEMI patients who underwent transradial angiography (TRA) compared to transfemoral angiography (TFA). Our outcomes of interest were major adverse cardiac events (MACE), all-cause mortality, severe bleeding, access site bleeding, myocardial infarction, stroke, and major vascular complications. Summary statistics are reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS In a pooled analysis of 17 RCTs with 12,118 randomized patients, the use of transradial compared to transfemoral approach in STEMI patients without cardiogenic shock was associated with a significant reduction in MACE [OR 0.85 (95% CI 0.73-0.99; p = 0.04; NNT = 111; I2 = 0%)] and all-cause mortality [OR 0.71 (95% CI 0.57-0.88; p < 0.01; NNT = 111; I2 = 0%)]. Severe bleeding [OR 0.57 (95% CI 0.44-0.74; p < 0.01; NNT = 77; I2 = 0%)], access-site bleeding [OR 0.39 (95% CI 0.26-0.59; p < 0.01; NNT = 67; I2 = 24%)], and major vascular complications [OR of 0.31 (95% CI 0.17-0.55; p < 0.01; NNT = 125; I2 = 0%)] were lower in TRA compared to TFA. There was no difference in stroke (0.6% vs 0.5%) or recurrent myocardial infarction (2.01% vs 2.02%) between the two approaches. CONCLUSIONS For coronary intervention in STEMI patients without cardiogenic shock, there is a clear mortality benefit with the TRA over TFA. Further studies are needed to see if this mortality benefit persists over the long-term.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Suchith S Shetty
- Division of Cardiology, Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, USA
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Ammar Athar
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Robert J Timmermans
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Howard A Cooper
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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19
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Spirito A, Gragnano F, Corpataux N, Vaisnora L, Galea R, Svab S, Gargiulo G, Siontis GCM, Praz F, Lanz J, Billinger M, Hunziker L, Stortecky S, Pilgrim T, Capodanno D, Urban P, Pocock S, Mehran R, Heg D, Windecker S, Räber L, Valgimigli M. Sex-Based Differences in Bleeding Risk After Percutaneous Coronary Intervention and Implications for the Academic Research Consortium High Bleeding Risk Criteria. J Am Heart Assoc 2021; 10:e021965. [PMID: 34098740 PMCID: PMC8477884 DOI: 10.1161/jaha.121.021965] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Female sex was not included among the high bleeding risk (HBR) criteria by the Academic Research Consortium (ARC) as it remains unclear whether it constitutes an HBR condition after percutaneous coronary intervention. We investigated whether female sex associates with HBR and assessed the performance of ARC HBR criteria separately in women and men. Methods and Results Among all consecutive patients undergoing percutaneous coronary intervention between 2009 and 2018, bleeding occurrences up to 1 year were prospectively collected and centrally adjudicated. All but one of the originally defined ARC HBR criteria were assessed, and the ARC HBR score generated accordingly. Among 16 821 patients, 25.6% were women. Compared with men, women were older and had lower creatinine clearance and hemoglobin values. After adjustment, female sex was independently associated with access‐site (adjusted hazard ratio, 2.14; 95% CI, 1.22–3.74; P=0.008) but not with overall or non–access‐site 1‐year Bleeding Academic Research Consortium 3 or 5 bleeding. This association remained consistent when the femoral but not the radial approach was chosen. The ARC HBR score discrimination, using the original criteria, was lower among women than men (c‐index 0.644 versus 0.688; P=0.048), whereas a revised ARC HBR score, in which age, creatinine clearance, and hemoglobin were modeled as continuous rather than dichotomized variables, performed similarly in both sexes. Conclusions Female sex is an independent predictor for access‐site bleeding but not for overall bleeding events at 1 year after percutaneous coronary intervention. The ARC HBR framework shows an overall good performance in both sexes, yet is lower in women than men, attributable to dichotomization of age, creatinine clearance, and hemoglobin values, which are differently distributed between sexes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.
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Affiliation(s)
| | - Felice Gragnano
- Department of Cardiology Bern University Hospital Bern Switzerland.,Division of Cardiology Department of Translational Medicine University of Campania "Luigi Vanvitelli Caserta Italy
| | - Noé Corpataux
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Lukas Vaisnora
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Roberto Galea
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Stefano Svab
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy
| | | | - Fabien Praz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Jonas Lanz
- Department of Cardiology Bern University Hospital Bern Switzerland
| | | | - Lukas Hunziker
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Stefan Stortecky
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Thomas Pilgrim
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Davide Capodanno
- Division of Cardiology Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" University of Catania Catania Italy
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine London United Kingdom
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Dik Heg
- Clinical Trial Unit Bern University of Bern Switzerland
| | | | - Lorenz Räber
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland.,Istituto Cardiocentro Ticino Ente Ospedaliero Cantonale Lugano Switzerland
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20
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Gender-related Disparities of Percutaneous Coronary Interventions in ST-elevation Myocardial Infarction: A Retrospective Chart Review of 500 Patients. Crit Pathw Cardiol 2021; 20:63-66. [PMID: 32769483 DOI: 10.1097/hpc.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Door-to-balloon (DTB) time of primary percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI) is a predictive indicator of outcomes and mortality. Traditional gender-related differences that existed in the provision of DTB in STEMI had been allegedly improving until recent controversial data showed re-emergence of longer DTB in females. The objective of our study was to compare circadian disparities in percutaneous coronary intervention for STEMI according to gender in our institution. We compared DTB and symptom-to-balloon (STB) as well as mortality outcomes in a registry of 514 patients. We studied 117 females and 397 males. Baseline characteristics and cardiovascular risk factors were similar among both populations. Men used more self-transportation (51% vs. 38%) compared with women. Both had similar DTB median times: males, 63 (47-79) min; and females, 61 (44-76) min. In addition, STB median times were also similar: males, 155 (116-264) min; and females, 165 (115-261) min. Mortality outcomes at 1 month were comparable at 3% in males versus 0.9% in females (P = 0.164). In a review of a tertiary care center in New York, we observed no gender differences in DTB and STB, endorsing the role of emergency medical service transportation in eliminating disparities.
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21
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Dillinger JG, Ducrocq G, Elbez Y, Cohen M, Bode C, Pollack C, Petrauskiene B, Henry P, Dorobantu M, French WJ, Wiviott SD, Sabatine MS, Mehta SR, Steg PG. Sex Differences in Ischemic and Bleeding Outcomes in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights From the TAO Trial. Circ Cardiovasc Interv 2021; 14:e009759. [PMID: 33430604 DOI: 10.1161/circinterventions.120.009759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have observed poorer outcomes in females with myocardial infarction, but older age and lower use of percutaneous coronary intervention in females are factors that potentially explain the worse outcome. This study sought to determine if female sex is an independent factor of ischemic and bleeding outcomes in non-ST-segment-elevation acute coronary syndrome treated with a systematic invasive approach. METHODS The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with non-ST-segment-elevation acute coronary syndrome treated invasively to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, the primary ischemic end point (all-cause death, myocardial infarction within 180 days) and the primary safety end point (Thrombolysis in Myocardial Infarction major or minor bleeding within 30 days) were analyzed according to sex. RESULTS Of 13 229 randomized patients, 3980 (30.1%) were females and 9249 (69.9%) were males. Females were older (64.8±11.0 versus 60.7±11.1 years), had more comorbidities, received less peri-procedural antithrombotic therapy, and underwent less frequently revascularization. Overall, females experienced a higher risk of ischemic (10.2% versus 9.1%; odds ratio [OR], 1.15 [1.01-1.30]) and bleeding events (4.2% versus 3.4%; OR, 1.23 [1.02-1.49]) than males. After multivariate analysis, the risk of ischemic outcomes (OR, 1.04 [0.90-1.19]), death (OR, 1.00 [0.75-1.23]), or bleeding (OR, 1.05 [0.85-1.28]), were similar between females and males. Only, noncoronary artery bypass graft related Thrombolysis in Myocardial Infarction major bleeding were increased in females (OR, 1.69 [1.11-2.56]). CONCLUSIONS In patients with non-ST-segment-elevation acute coronary syndrome with systematic invasive management, ischemic outcomes, bleeding events, and mortality were higher in females. After multivariate analyses, female sex was not an independent predictor of ischemic and bleeding events although noncoronary artery bypass graft related Thrombolysis in Myocardial Infarction major bleeding was higher in females. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01076764.
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Affiliation(s)
| | - Gregory Ducrocq
- Université de Paris, AP-HP, FACT, FHU APOLLO, Hôpital Bichat, Inserm U-1148, Paris, France (G.D., Y.E., P.G.S.)
| | - Yedid Elbez
- Université de Paris, AP-HP, FACT, FHU APOLLO, Hôpital Bichat, Inserm U-1148, Paris, France (G.D., Y.E., P.G.S.)
| | - Marc Cohen
- Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School (M.C.)
| | - Christoph Bode
- Medizinische Universitatsklinik, Freiburg, Germany (C.B.)
| | - Charles Pollack
- University of Mississippi School of Medicine, Jackson (C.P.)
| | | | - Patrick Henry
- Université de Paris, Hôpital Lariboisière, AP-HP, Inserm U-942, Paris, France (J.-G.D., P.H.)
| | | | - William J French
- Harbor-University of California, Los Angeles Medical Center, Torrance, CA (W.J.F.)
| | - Stephen D Wiviott
- TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.D.W., M.S.S.)
| | - Marc S Sabatine
- TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (S.D.W., M.S.S.)
| | - Shamir R Mehta
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.R.M.)
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP, FACT, FHU APOLLO, Hôpital Bichat, Inserm U-1148, Paris, France (G.D., Y.E., P.G.S.).,Royal Brompton Hospital, Imperial College, London, United Kingdom (P.G.S.)
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22
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Kühn AL, Singh J, de Macedo Rodrigues K, Massari F, Moholkar VM, Marwah SK, Unar D, Gounis MJ, Puri AS. Distal radial artery (Snuffbox) access for intracranial aneurysm treatment using the Woven EndoBridge (WEB) device. J Clin Neurosci 2020; 81:310-315. [DOI: 10.1016/j.jocn.2020.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 01/25/2023]
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Singh K, Tavella R, Air T, Worthley M, Sinhal A, Arstall M, Zeitz C, Beltrame J. Impact of Young Age and Gender on Outcomes of Transradial Versus Transfemoral Access Coronary Angiography. Angiology 2020; 72:228-235. [PMID: 32969268 DOI: 10.1177/0003319720961940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The differential impact of young age and female gender on transradial access (TRA) outcomes remains to be confirmed. The primary objective was to assess the impact of young age and female gender on in-hospital net adverse cardiovascular events (NACE). Among 12 346 patients from the Coronary Angiogram Database of South Australia (CADOSA) Registry, the impact of gender; men (transfemoral access [TFA] 1995, TRA 6168) and women (TFA 1249, TRA 2934), and a median split of age, ≤63 years (TFA 1617, TRA 4727) and >63 years (TFA 1627, TRA 4375) were analyzed on in-hospital outcomes by creating 5 separate propensity-matched cohorts (entire cohort, men, women, ≤63 and > 63 years). Net adverse cardiovascular event reduction with TRA was limited to the >63 years old cohort (odds ratio [OR] = 0.56, 95% CI: 0.34-0.93, P = .02) and women (OR = 0.37, 95% CI: 0.18-0.76, P = .007). In both the age groups and genders, TRA was associated with a lower risk of bleeding and all-cause mortality. On multivariate logistic regression, TRA was associated with a significant reduction in NACE, major bleeding, and mortality in the overall cohort. In conclusion, a reduction in bleeding and mortality was noted with TRA in all the subgroups in this observational study.
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Affiliation(s)
- Kuljit Singh
- Department of Medicine, 60093Griffith University, Gold Coast, Queensland, Australia
| | - Rosanna Tavella
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Tracy Air
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew Worthley
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Ajay Sinhal
- Department of Medicine, 1065Flinders University, Adelaide, South Australia, Australia
| | - Margaret Arstall
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher Zeitz
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - John Beltrame
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Stehli J, Duffy SJ, Koh Y, Martin C, Brennan A, Dinh DT, Lefkovits J, Zaman S. Sex Differences in Radial Access for Percutaneous Coronary Intervention in Acute Coronary Syndrome Are Independent of Body Size. Heart Lung Circ 2020; 30:108-114. [PMID: 32855068 DOI: 10.1016/j.hlc.2020.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/22/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radial access reduces bleeding and is associated with improved survival following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We evaluated the association between sex, markers of body size and radial access, and its impact on bleeding and mortality following PCI for ACS. METHODS AND RESULTS From 2013-2016, consecutive patients treated with PCI for ACS across 30 centres were prospectively entered into the Victorian Cardiac Outcomes Registry and followed for 30 days. Multivariate logistic regression was used to analyse predictors of the primary endpoint of PCI access site and secondary endpoints of major bleeding and mortality. A total of 16,330 ACS patients (40.9% ST elevation myocardial infarction [STEMI]) underwent PCI (23.5% female). Women were older with significantly lower weight and height compared to men. Women had lower radial access use (41.6% versus 51.0%, p<0.001), with higher 30-day major bleeding (2.4% versus 1.4%, p<0.001) and mortality (4.4% versus 3.4%, p<0.001) than men. Female sex independently predicted lower radial access use (OR 0.75, 95% CI 0.68-0.83, p<0.001) while body surface area, height and body mass index did not. Female sex was an independent predictor of higher 30-day major bleeding (OR 1.38, 95% CI 1.05-1.81, p=0.019) and mortality in STEMI patients (OR 1.31, 95% CI 1.01-1.70. p=0.039). Radial access was associated with lower major bleeding (OR 0.70, 95% CI 0.53-0.91, p=0.009) and mortality (OR 0.60, 95% CI 0.48-0.75, p<0.001). CONCLUSIONS Radial access, despite being associated with lower bleeding and mortality, was used less frequently in women, independent of co-morbidities and objective markers of body size.
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Affiliation(s)
- Julia Stehli
- Cardiology Department, The Alfred Hospital, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Cardiology Department, The Alfred Hospital, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Youlin Koh
- Cardiology Department, The Alfred Hospital, Melbourne, Vic, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic, Australia
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic, Australia; Cardiology Department, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Sarah Zaman
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia; Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.
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25
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Sex Disparities in Myocardial Infarction: Biology or Bias? Heart Lung Circ 2020; 30:18-26. [PMID: 32861583 DOI: 10.1016/j.hlc.2020.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/19/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion-widespread in the community and health care providers-that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where "time is muscle". Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guideline-directed medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant-with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both?
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26
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Stehli J, Martin C, Brennan A, Dinh DT, Lefkovits J, Zaman S. Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention. J Am Heart Assoc 2020; 8:e012161. [PMID: 31092091 PMCID: PMC6585344 DOI: 10.1161/jaha.119.012161] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Timely revascularization with percutaneous coronary intervention (PCI) reduces death following myocardial infarction. We evaluated if a sex gap in symptom‐to‐door (STD), door‐to‐balloon (DTB), and door‐to‐PCI time persists in contemporary patients, and its impact on mortality. Methods and Results From 2013 to 2016 the Victorian Cardiac Outcomes Registry prospectively recruited 13 451 patients (22.5% female) from 30 centers with ST‐segment–elevation myocardial infarction (STEMI, 47.8%) or non–ST‐segment–elevation myocardial infarction (NSTEMI) (52.2%) who underwent PCI. Adjusted log‐transformed STD and DTB time in the STEMI cohort and STD and door‐to‐PCI time in the NSTEMI cohort were analyzed using linear regression. Logistic regression was used to determine independent predictors of 30‐day mortality. In STEMI patients, women had longer log‐STD time (adjusted geometric mean ratio 1.20, 95% CI 1.12‐1.28, P<0.001), log‐DTB time (adjusted geometric mean ratio 1.12, 95% CI 1.05‐1.20, P=0.001), and 30‐day mortality (9.3% versus 6.5%, P=0.005) than men. Womens’ adjusted geometric mean STD and DTB times were 28.8 and 7.7 minutes longer, respectively, than were mens’ times. Women with NSTEMI had no difference in adjusted STD, door‐to‐PCI time, or early (<24 hours) versus late revascularization, compared with men. Female sex independently predicted a higher 30‐day mortality (odds ratio 1.67, 95% CI 1.11‐2.49, P=0.01) in STEMI but not in NSTEMI. Conclusions Women with STEMI have significant delays in presentation and revascularization with a higher 30‐day mortality compared with men. The delay in STD time was 4‐fold the delay in DTB time. Women with NSTEMI had no delay in presentation or revascularization, with mortality comparable to men. Public awareness campaigns are needed to address women's recognition and early action for STEMI. See Editorial Gulati
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Affiliation(s)
- Julia Stehli
- 1 Cardiology Department The Alfred Hospital Melbourne Australia
| | - Catherine Martin
- 2 Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Angela Brennan
- 3 Centre of Cardiovascular Research and Education in Therapeutics Monash University Melbourne Australia
| | - Diem T Dinh
- 3 Centre of Cardiovascular Research and Education in Therapeutics Monash University Melbourne Australia
| | - Jeffrey Lefkovits
- 3 Centre of Cardiovascular Research and Education in Therapeutics Monash University Melbourne Australia.,4 Cardiology Department Royal Melbourne Hospital Melbourne Australia
| | - Sarah Zaman
- 5 Monash Cardiovascular Research Centre Monash University Melbourne Australia.,6 Monash Heart Monash Medical Centre Melbourne Australia
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Widimsky P, Crea F, Binder RK, Lüscher TF. The year in cardiology 2018: acute coronary syndromes. Eur Heart J 2020; 40:271-282. [PMID: 30601993 DOI: 10.1093/eurheartj/ehy904] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/26/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Ruska 87, Prague 10, Czech Republic
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Policlinico A. Gemelli-IRCCS, Catholic University, Roma, Italy
| | - Ronald K Binder
- Cardiology and Intensive Care, University Teaching Hospital Klinikum Wels Grieskirchen, A-4600 Wels, Austria
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College, London, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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28
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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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Roque D, Ferreira J, Monteiro S, Costa M, Gil V. Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. Rev Port Cardiol 2020; 39:57-72. [PMID: 32205012 DOI: 10.1016/j.repc.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality. OBJECTIVE The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods. METHODS We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology. RESULTS A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p<0.001 for all) and dyslipidemia (p=0.022) were all more prevalent in women, who were more frequently admitted for non-ST segment elevation ACS (p<0.001), and more frequently presented with atypical symptoms. Women had more time until needle and until reperfusion, which is less accessible to this gender (p<0.001). During hospitalization, women had a significantly higher risk of in-hospital mortality (OR 1.94 [1.78-2.12], p<0.001), major bleeding (OR 1.53 [1.30-1.80], p<0.001), heart failure (OR 1.87 [1.78-1.97], p<0.001), atrial fibrillation (OR 1.55 [1.36-1.77], p<0.001), mechanical complications (OR 2.12 [1.78-2.53], p<0.001), cardiogenic shock (OR 1.71 [1.57-1.87], p<0.001) and stroke (OR 2.15 [1.76-2.62], p<0.001). Women were more likely to have a normal coronary angiogram or coronary lesions with <50% luminal stenosis (p<0.001 for both), and thus a final diagnosis other than ACS. Both during hospitalization and at hospital discharge, women were less likely to receive guideline-recommended secondary prevention therapy. CONCLUSION In women admitted for ACS, revascularization strategies are still underused, as is guideline-recommended secondary prevention therapy, which may explain their higher incidence of in-hospital complications and higher unadjusted mortality.
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Affiliation(s)
- David Roque
- Cardiology Department, Hospital Prof. Dr. Fernando da Fonseca Hospital, Amadora, Portugal.
| | - Jorge Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Victor Gil
- Cardiovascular Unit, Hospital dos Lusíadas, Lisbon University, Lisbon, Portugal
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30
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Ford TJ, Khan A, Docherty KF, Jackson A, Morrow A, Sidik N, Rocchiccioli P, Good R, Eteiba H, Watkins S, Shaukat A, Lindsay M, Robertson K, Petrie M, Berry C, Oldroyd KG, McEntegart M. Sex differences in procedural and clinical outcomes following rotational atherectomy. Catheter Cardiovasc Interv 2020; 95:232-241. [PMID: 31264314 PMCID: PMC7027486 DOI: 10.1002/ccd.28373] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/16/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022]
Abstract
AIM Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA). METHODS AND RESULTS From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001). CONCLUSION Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long-term survival free of major adverse cardiac events was similar between males and females.
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Affiliation(s)
- Thomas J. Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
- Gosford HospitalNSWAustralia
| | - Adnan Khan
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Kieran F. Docherty
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Alice Jackson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Novalia Sidik
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mark Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Keith G. Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
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Understanding a woman's heart: Lessons from 14 177 women with acute coronary syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Akl E, Rashid MK, Alshatti A, Jolly SS. Transradial Angiography and Intervention in Acute Coronary Syndromes. Interv Cardiol Clin 2020; 9:33-40. [PMID: 31733739 DOI: 10.1016/j.iccl.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Considerable evidence supports transradial angiography and intervention in patients with acute coronary syndrome, with an emphasis on decreasing major bleeding and access site vascular complications. Patients undergoing invasive treatment are at greatest risk of bleeding and have the most to gain. The radial advantage has consistently been shown to translate into reduced mortality in pooled data analyses. The benefits of transradial access have been demonstrated across the acute coronary syndrome spectrum and in both sexes. A radial-first strategy should be the default approach and continuous efforts should be made to increase operator expertise of transradial access in these patients.
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Affiliation(s)
- Elie Akl
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Mohammed K Rashid
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Ahmad Alshatti
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sanjit S Jolly
- Department of Medicine, Division of Cardiology, McMaster University, Room C3-118, DBCVSRI Building, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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Kim KH, Rha SW. EDITORIAL: Is There Sex Difference in Clinical Outcomes Following Coronary Chronic Total Occlusion Intervention? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:32-33. [PMID: 31732421 DOI: 10.1016/j.carrev.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Kyung-Hee Kim
- Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.
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Gewalt SM, Helde SM, Ibrahim T, Mayer K, Schmidt R, Bott-Flügel L, Hoppe K, Ott I, Hieber J, Morath T, Byrne RA, Kufner S, Cassese S, Hoppmann P, Fusaro M, Schunkert H, Laugwitz KL, Kastrati A, Schüpke S. Comparison of Vascular Closure Devices Versus Manual Compression After Femoral Artery Puncture in Women. Circ Cardiovasc Interv 2019; 11:e006074. [PMID: 30354782 DOI: 10.1161/circinterventions.117.006074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of vascular closure devices (VCD) in women undergoing transfemoral catheterization has not been sufficiently investigated. METHODS AND RESULTS This is a sex-specific analysis of 1395 women enrolled in a large-scale, randomized, multicenter trial, in which patients undergoing transfemoral diagnostic coronary angiography were randomly assigned in a 1:1:1 ratio to arteriotomy closure with an intravascular VCD, extravascular VCD, or manual compression (MC). Primary objective was to assess the safety and efficacy of 2 different VCD compared with MC regarding vascular access-site complications at 30 days. A secondary comparison was between 2 different types of contemporary VCD. Overall, women were at higher risk for vascular access-site complications compared with men (9.0% versus 6.4%; P=0.002). Vascular access-site complications were comparable in women assigned to VCD and MC (8.6% versus 9.8%; P=0.451). There was no interaction of treatment effect and sex ( Pinteraction=0.970). Time to hemostasis was significantly shortened with VCD compared with MC (1 [interquartile range, 0.5-2.0] minutes) versus 11 [interquartile range, 10-15] minutes; P<0.001); however, more women with VCD required repeat MC (2.4% versus 0.6%; P=0.018). The use of the intravascular compared with the extravascular VCD was associated with a numerical reduction in vascular access-site complications (6.6% versus 10.7%; P=0.027) and significant reductions in time to hemostasis and VCD failure. CONCLUSIONS In women undergoing diagnostic coronary angiography via the common femoral artery, VCD and MC provided comparable safety, while time to hemostasis was reduced with VCD. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01389375.
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Affiliation(s)
- Senta M Gewalt
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Sandra M Helde
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,Klinikum Landkreis Erding, Abteilung Kardiologie und Pneumologie, Germany (S.M.H., L.B.-F.)
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.)
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Roland Schmidt
- Krankenhaus der Barmherzigen Brüder, Innere Medizin II, Munich, Germany (R.S.)
| | - Lorenz Bott-Flügel
- Klinikum Landkreis Erding, Abteilung Kardiologie und Pneumologie, Germany (S.M.H., L.B.-F.)
| | - Katharina Hoppe
- German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Julia Hieber
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Tanja Morath
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Petra Hoppmann
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.)
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
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35
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Residual angina in female patients after coronary revascularization. Int J Cardiol 2019; 286:208-213. [DOI: 10.1016/j.ijcard.2019.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
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Völz S, Angerås O, Koul S, Haraldsson I, Sarno G, Venetsanos D, Grimfärd P, Ulvenstam A, Hofmann R, Hamid M, Henareh L, Wagner H, Jensen J, Danielewicz M, Östlund O, Eriksson P, Scherstén F, Linder R, Råmunddal T, Pétursson P, Fröbert O, James S, Erlinge D, Omerovic E. Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 8:510-519. [PMID: 31237158 DOI: 10.1177/2048872618817217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin. METHODS AND RESULTS A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801). CONCLUSIONS Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - Per Grimfärd
- Department of Internal Medicine, Västmanlands Sjukhus, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | - Mehmet Hamid
- Department of Cardiology, Mälarsjukhuset, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Sweden
| | - Henrik Wagner
- Department of Cardiology, Helsingborg Lasarett, Sweden
| | - Jens Jensen
- Department of Clinical Science and Education, Karolinska Institutet, Sweden.,Unit of Cardiology, Capio S:t Görans Sjukhus, Sweden
| | | | - Ollie Östlund
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | | | | | | | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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Gargiulo G, da Costa BR, Frigoli E, Palmieri C, Nazzaro MS, Falcone C, Liso A, Vigna C, Abate F, Comeglio M, Diletti R, Gabrielli G, Di Lorenzo E, Mazzarotto P, Zimarino M, Moretti C, Colombo A, Penzo C, Pasquetto G, Brugaletta S, Ferrari F, Casu G, Guiducci V, Dellavalle A, Liistro F, Mauro C, van't Hof AW, Omerovic E, Curello S, de la Torre Hernandez JM, De Servi S, Belloni F, Windecker S, Valgimigli M. Impact of sex on comparative outcomes of bivalirudin versus unfractionated heparin in patients with acute coronary syndromes undergoing invasive management: a pre-specified analysis of the MATRIX trial. EUROINTERVENTION 2019; 15:e269-e278. [DOI: 10.4244/eij-d-18-00247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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38
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Chester RC, Mina SA, Lewis B, Zhang N, Butterfield R, Yang EH. Radial artery access is under‐utilized in women undergoing PCI despite potential benefits: Mayo Clinic PCI Registry. Catheter Cardiovasc Interv 2019; 95:675-683. [DOI: 10.1002/ccd.28341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Bradley Lewis
- Department of Biomedical Statistics and InformaticsMayo Clinic Rochester Minnesota
| | - Nan Zhang
- Division of Health Sciences ResearchMayo Clinic Arizona Minnesota
| | | | - Eric H. Yang
- Department of CardiologyMayo Clinic Scottsdale Arizona
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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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40
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Deora S. Transradial approach - Female population and radiation exposure an important aspect. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:985-986. [PMID: 30045815 DOI: 10.1016/j.carrev.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Surender Deora
- All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India.
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Vascular Access-Related Complications in Women: Temporal Trends, Emerging Data, and the Current State of Interventional Cardiology Practice. Curr Atheroscler Rep 2018; 20:41. [DOI: 10.1007/s11883-018-0741-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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42
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Huded CP, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett TC, Hantz S, Ellis SG, Podolsky SR, Meldon SW, Kralovic DM, Brosovich D, Smith E, Kapadia SR, Khot UN. 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. J Am Coll Cardiol 2018. [PMID: 29535061 DOI: 10.1016/j.jacc.2018.02.039] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown. OBJECTIVES The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol. METHODS On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol. RESULTS Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090). CONCLUSIONS A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.
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Affiliation(s)
- Chetan P Huded
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Johnson
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mouin Abdallah
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Travis C Gullett
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Scott Hantz
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen G Ellis
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Seth R Podolsky
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Stephen W Meldon
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Damon M Kralovic
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | | | - Elizabeth Smith
- Emergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Umesh N Khot
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Plourde G, Bertrand OF. Radial Access in Women for Percutaneous Coronary Intervention: Toward the End of the Sex Paradox? JACC Cardiovasc Interv 2018; 11:51-52. [PMID: 29301647 DOI: 10.1016/j.jcin.2017.10.025] [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: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Guillaume Plourde
- Interventional Cardiology Laboratories, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada
| | - Olivier F Bertrand
- Interventional Cardiology Laboratories, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
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