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Alexanderson-Rosas E, Antonio-Villa NE, Sanchez-Favela M, Carvajal-Juarez I, Oregel-Camacho D, Gopar-Nieto R, Flores-Garcia AN, Keirns C, Hernandez-Sandoval S, Espinola-Zavaleta N. Assessment of Atypical Cardiovascular Risk Factors Using Single Photon Emission Computed Tomography in Mexican Women. Arch Med Res 2021; 52:648-655. [PMID: 33896676 DOI: 10.1016/j.arcmed.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) is a health care problem in women that increases morbimortality, particularly in developing countries. There is limited information regarding atypical risk factors associated with IHD in Mexican women. AIM To explore risk factors in women that could contribute to IHD and myocardial dysfunction using the single photon emission computed tomography (SPECT) myocardial perfusion study (MPS). METHODS We designed a cross-sectional study in which we evaluated atypical and typical risk factors using a clinical questionnaire. We performed a SPECT-MPS to evaluate the presence of ischemia/infarction, decreased left ventricular ejection fraction, systolic dyssynchrony and diastolic function by peak filling rate and time to peak filling rate. RESULTS 172 women were included, 64 with IHD. Adverse events during pregnancy (premature birth and miscarriage), rheumatoid arthritis, gynecological conditions (menopause and age of first menstruation) and low educational level, together with previously known typical risk factors were associated with infarction or ischemia and ventricular dysfunction. Potential associated factors for systolic dyssynchrony were rheumatoid arthritis (OR: 2.90, 95% CI: 0.95-8.66, p = 0.054) and history of premature birth (OR: 0.13, 95% CI: 0.01-0.66, p <0.01). Although those women with arterial hypertension and smoking shown an increased risk for dyssynchrony, these factors were not statistically significant. Low-educational level (OR 2.16, 95% CI 1.1-4.18, p = 0.019) was associated with decreased peak filling rate. CONCLUSION The presence of atypical risk factors in women could lead to decreased myocardial function, particularly in women at risk of developing IHD.
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Affiliation(s)
- Erick Alexanderson-Rosas
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México; Departamento de fisiología, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de México, México
| | - Neftali Eduardo Antonio-Villa
- Plan de Estudios Combinados en Medicina, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de México, México
| | - Miguel Sanchez-Favela
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México
| | - Isabel Carvajal-Juarez
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México
| | - Diego Oregel-Camacho
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México
| | - Rodrigo Gopar-Nieto
- Departamento de Docencia, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México
| | - Alondra N Flores-Garcia
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México
| | - Candace Keirns
- International Medical Interpreters Association, Boston Massachusetts, USA
| | - Salvador Hernandez-Sandoval
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México
| | - Nilda Espinola-Zavaleta
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ignacio Chavez, Ciudad de México, México; Departamento de Ecocardiografía, Centro Médico ABC, Instituciones de Asistencia Privada, Ciudad de México, México.
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Ischemic Etiology and Prognosis in Men and Women with Acute Heart Failure. J Clin Med 2021; 10:jcm10081713. [PMID: 33921155 PMCID: PMC8071524 DOI: 10.3390/jcm10081713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary heart disease is common in heart failure (HF). Our aim was to determine the impact of ischemic etiology on prognosis among men and women with HF. This study is a prospective national multicenter registry. The primary endpoint was 12-month mortality. Patients with HF and ischemic heart disease were stratified according to sex. A total of 1830 patients were enrolled of which 756 (41.3%) were women. Ischemic etiology was more common in men (446 (41.6%)) than in women (167 (22.2%)). Among patients with ischemic HF, diabetes was more frequent in women than in men. Ischemic etiology was not associated with higher mortality risk, and this was true for women (Hazard Ratio [HR] 1.51, 95% Confidence Interval [CI] 0.98–2.32; p = 0.61) and men (HR 1.14, 95% CI 0.81–1.61; p = 0.46), p-value for interaction: 0.067. Mortality/readmission risk in ischemic HF increased in men with previous readmissions (HR 1.15, 95% CI 1.02–1.29; p = 0.022), chronic obstructive pulmonary disease (HR1.20, 95% CI 1.02–1.41; p = 0.026) and in women with diabetes (HR 2.23, 95% CI 1.05–4.47; p = 0.035). Ischemic etiology was not associated with mortality in HF patients. In ischemic HF, the variables associated with a poor prognosis were diabetes in women and previous readmissions and chronic obstructive pulmonary disease in men.
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Gong X, Zhou L, Ding X, Li H, Chen H. A sex-stratified long-term clinical outcome analysis in coronary chronic total occlusion patients. Biol Sex Differ 2021; 12:9. [PMID: 33419425 PMCID: PMC7796539 DOI: 10.1186/s13293-020-00354-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Differences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI. Methods A total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. Three hundred patients were revascularized by PCI, and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; hazard ratios were generated using multivariable Cox regression. Results Women represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men; however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow-up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p = 0.234) and cardiac death (3.1% vs 5.6%, p = 0.202). Predictors of CTO recanalization revealed that age < 65 years, absence of prior CABG, no history of DM, and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE. Conclusion Our study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.
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Affiliation(s)
- Xuhe Gong
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China
| | - Li Zhou
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China.,Department of Internal Medicine, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, 100069, People's Republic of China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Road 95 Yongan Xicheng District, Beijing, 100050, People's Republic of China.
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Garay A, Tapia J, Anguita M, Formiga F, Almenar L, Crespo-Leiro MG, Manzano L, Muñiz J, Chaves J, De Frutos T, Moliner P, Corbella X, Enjuanes-Grau C, Comín-Colet J. Gender Differences in Health-Related Quality of Life in Patients with Systolic Heart Failure: Results of the VIDA Multicenter Study. J Clin Med 2020; 9:jcm9092825. [PMID: 32878281 PMCID: PMC7563299 DOI: 10.3390/jcm9092825] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
Previous studies have shown that heart failure is associated with worse health-related quality of life (HRQoL). The existence of differences according to gender remains controversial. We studied 1028 consecutive outpatients with heart failure and reduced ejection fraction (HFrEF) from a multicentre cross-sectional descriptive study across Spain that assessed HRQoL using two questionnaires (KCCQ, Kansas City Cardiomyopathy Questionnaire; and EQ-5D, EuroQoL 5 dimensions). The primary objective of the study was to describe differences in HRQoL between men and women in global scores and domains of health status of patients and explore gender differences and its interactions with heart failure related factors. In adjusted analysis women had lower scores in KCCQ overall summary scores when compared to men denoting worse HRQoL (54.7 ± 1.3 vs. 62.7 ± 0.8, p < 0.0001), and specifically got lower score in domains of symptom frequency, symptoms burden, physical limitation, quality of life and social limitation. No differences were found in domains of symptom stability and self-efficacy. Women also had lower scores on all items of EQ-5D (EQ-5D index 0.58 ± 0.01 vs. 0.67 ± 0.01, p < 0.0001). Finally, we analyzed interaction between gender and different clinical determinants regarding the presence of limitations in the 5Q-5D and overall summary score of KCCQ. Interestingly, there was no statistical significance for interaction for any variable. In conclusion, women with HFrEF have worse HRQoL compared to men. These differences do not appear to be mediated by clinical or biological factors classically associated with HRQoL nor with heart failure severity.
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Affiliation(s)
- Alberto Garay
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Javier Tapia
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Departamento de Ciencias Clínicas, Universidad de Barcelona, 08907 Barcelona, Spain
| | - Manuel Anguita
- Unidad de Insuficiencia Cardíaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba 14004, Argentina;
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
| | - Luis Almenar
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitario La Fe, 46009 Valencia, Spain;
| | - María G. Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), 15006 A Coruña, Spain;
| | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, 28034 Madrid, Spain;
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 La Coruña, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 15705 Santiago de Compostela, Spain
| | - José Chaves
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Trinidad De Frutos
- Medical Department, Internal Medicine, Pfizer Biopharmaceuticals Group, 28108 Alcobendas, Spain; (J.C.); (T.D.F.)
| | - Pedro Moliner
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unidad de Cardio-Oncología Hospital de Bellvitge–Instituto Catalán de Oncología, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Xavier Corbella
- Servicio de Medicina Interna, Hospital Universitario de Bellvitge, l’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.F.); (X.C.)
- Cátedra HESTIA en Atención Integrada Social y Sanitaria, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08017 Barcelona, Spain
| | - Cristina Enjuanes-Grau
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (P.M.); (C.E.-G.)
- Programa Territorial de Atención Integrada a la Insuficiencia Cardiaca Comunitaria de la Gerencia Metropolitana Sur del Instituto Catalán de la Salud, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L’ Hospitalet de Llobregat, 08907 Barcelona, Spain;
- Servicio de Cardiologia, Hospital Universitario de Bellvitge, L’ Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-607-078
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Ruiz-Pizarro V, Ferrera C, Gómez-Polo JC, Palacios-Rubio J, Rico-García Amado C, Fernández-Ortiz A, Viana-Tejedor A. Sex differences in treatment and prognosis of acute coronary syndrome with interventional management. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:183-186. [PMID: 30905407 DOI: 10.1016/j.carrev.2018.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/09/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Female sex has been associated with differences in diagnostic and management of acute coronary syndrome (ACS). Our aim was to analyze sex differences in ACS with interventional management in a tertiary care hospital. METHODS Patients with ACS admitted to a Spanish tertiary care referral center were included prospectively and consecutively. All patients included in the study underwent a coronary angiography. RESULTS From the total cohort of 1214 patients, 290 (24%) were women. Women were older (71 ± 12.8 vs 64 ± 13.4 years, p < 0.001) and showed lower ischemic risk and higher hemorrhagic risk scores (GRACE 159 ± 45 vs 171 ± 42, p = 0.005; CRUSADE 41 ± 19 vs 28 ± 17, p < 0.001). There were no significant differences in time to coronary angiography and revascularization rates between sex groups. A lower proportion of women received high-potency antiplatelet agents (29% vs 41.3%, p = 0.004). In-hospital evolution and one-year mortality were similar between groups. CONCLUSIONS In our population, there were no gender differences in management and prognosis of ACS. Differences in risk profile among groups could have an influence on antiplatelet therapy.
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Affiliation(s)
- Virginia Ruiz-Pizarro
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain.
| | - Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Juan Carlos Gómez-Polo
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Julián Palacios-Rubio
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Carmen Rico-García Amado
- Cardiology department, Hospital Universitario Severo Ochoa, Avenida de Orellana, s/n, 28911 Leganés, (Madrid), Spain
| | - Antonio Fernández-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
| | - Ana Viana-Tejedor
- Instituto Cardiovascular, Hospital Clínico San Carlos, C/Profesor Martin Lagos S/N, 28010, Madrid, (Madrid), Spain
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Sanmartín M, Del Val D. Ischemic heart disease in women: A pending issue? Rev Clin Esp 2015; 216:19-21. [PMID: 26708227 DOI: 10.1016/j.rce.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M Sanmartín
- Hospital Universitario Ramón y Cajal, Madrid, España.
| | - D Del Val
- Hospital Universitario Ramón y Cajal, Madrid, España
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Influence of gender on prognosis of acute coronary syndromes. Rev Port Cardiol 2015; 34:43-50. [PMID: 25578946 DOI: 10.1016/j.repc.2014.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 01/05/2014] [Accepted: 08/16/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Ischemic heart disease presents different features in men and women. We analyzed the relation between gender and prognosis in patients who had suffered a high-risk acute coronary syndrome (ACS). METHODS This was a prospective analytical cohort study performed at Lozano Blesa University Hospital, Zaragoza, Spain, of 559 patients diagnosed with high-risk ACS with and without ST-segment elevation according to the American College of Cardiology/American Heart Association guidelines. The sample was divided into two groups by gender and differences in epidemiologic, laboratory, electrocardiographic and echocardiographic variables and treatment were recorded. A Cox's proportional hazard model was applied and 6-month mortality was analyzed as the main variable. RESULTS The median age was 65.2±12.7 years, and 21.8% were women. Baseline characteristics in women were more unfavorable, with higher GRACE scores, older age, higher prevalence of hypertension, diabetes and heart failure, lower ejection fraction and more renal dysfunction at admission. Women suffered more adverse cardiovascular events (27.9% vs. 15.8%, p=0.002). Sixty-four patients died, 18.9% of the women vs. 9.4% of the men (p=0.004). After multivariate analysis, female gender did not present an independent relation with mortality. Hemoglobin level, renal function, ejection fraction and Killip class >1 presented significant differences. CONCLUSIONS Acute syndrome coronary in women has a worse prognosis than in men. Their adverse course is due to their baseline characteristics and not to their gender.
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Influence of gender on prognosis of acute coronary syndromes. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Vidal-Pérez R, Otero-Raviña F, Gómez Vázquez JL, Santos Rodríguez JA, De Frutos De Marcos C, González-Juanatey JR. Cardiopatía isquémica en la mujer. Datos del estudio CIBAR. Rev Esp Cardiol 2012; 65:1056-8. [DOI: 10.1016/j.recesp.2012.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 02/27/2012] [Indexed: 11/26/2022]
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Sancho Cantus D, Solano Ruiz MDC. Ischemic heart disease in women. Rev Lat Am Enfermagem 2012; 19:1462-9. [PMID: 22249683 DOI: 10.1590/s0104-11692011000600025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 10/04/2011] [Indexed: 11/22/2022] Open
Abstract
Nowadays, Coronary Diseases (CDs) represent the main mortality cause in men and women, but there are gender differences regarding their presentation, progression and the way the disease is tackled. This study mainly focuses on reviewing literature about the CD and its gender approach. The authors carried out a search of texts that use qualitative methodology, published between 2003 and 2009 in the following databases: PUBMED, IME, CUIDEN and CINAHL. Factors that hinder the early diagnosis of Ischemic Heart Disease in women are identified as the main findings, and the possible consequences are pointed out. In the fifty-six texts that were selected initially, we can see the difficulty women face to recognize early symptoms of the CD and their low risk perception of this disease. Greater awareness on Ischemic Heart Disease is needed, so that the high morbidity and mortality rates can be reduced.
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[Acute coronary syndrome in women. Gender differences]. Med Clin (Barc) 2011; 137:623-30. [PMID: 21939996 DOI: 10.1016/j.medcli.2011.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 03/02/2011] [Accepted: 03/03/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Our aims was to investigate possible gender differences in the diagnostic assessment, treatment and prognosis of patients admitted with acute coronary syndrome (ACS). PATIENTS AND METHODS Prospective study of a cohort of 396 patients consecutively admitted to the coronary unit in the period of 18 months with the diagnoses of ACS. We divided the sample into two groups based on gender: 294 men and 102 women. We analysed the diagnostic assessment, hospital treatment, coronary revascularization (ICP), appearance of heart failure (HF) and in-hospital and 1-year mortality. We analyzed predictors of mortality in a multivariate model. RESULTS Women were older (70.9±11.9 versus 64.4±12.0; P<.001) and had more comorbidities such as hypertension (70.5% versus 53.7%; P=.003), diabetes (51.0% versus 33.3%; P<.01) and HF (20.5% versus 9.1%; P<.01) than men, while men had greater frequency of smoking (54.42% versus 13.73%; P<.001). Women had higher incidence of cardiogenic shock on admission. There were no differences in thrombolysis and women did not have a different pattern of access to coronary angiography, but men had greater frequency of ICP (50.8% versus 34.6%; P<.01). Women were more likely to develop a higher in-hospital HF (32.6% versus 25.9%; P<.05) and in-hospital mortality (17.6% versus 4.7%; P<.001). In the multivariate analyses, HF on admission OR 8.98 (3.29-24.47), older age OR 1.07 (1.01-1.13) and female gender OR 3.14 (1.27-7.74), were independent predictors of in-hospital mortality. CONCLUSIONS In our study, female gender was an independent predictor of in-hospital mortality in patients with ACS.
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Sex differences in relative survival and prognostic factors in patients with a first acute myocardial infarction in Guipuzcoa, Spain. Rev Esp Cardiol 2010; 63:649-59. [PMID: 20515622 DOI: 10.1016/s1885-5857(10)70139-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine 28-day and 5-year survival rates in patients who have experienced a first acute myocardial infarction and to identify prognostic factors for survival. METHODS This study involved 1,677 patients with a first acute myocardial infarction who were treated at a hospital in Guipuzcoa, Spain between 1997 and 2000. RESULTS Women were approximately 10 years older than men, presented more often with diabetes and hypertension, were in a less favorable clinical condition, and consumed fewer medical resources, but were less likely to smoke. Survival rates at 28 days and 5 years were higher in men over 60 years of age. In the period from 29 days to 5 years, the relative survival rate was higher in men from all age groups. Factors associated with short- and long-term survival varied between the sexes. Disease severity in the acute phase and, later on, age were associated with survival in both men and women, whereas the effect of other variables differed between the sexes. CONCLUSIONS Myocardial infarction is a condition associated with high mortality in the acute phase. There is an interaction between sex and age that affects survival after an acute myocardial infarction. A number of factors are associated with poor short- and long-term prognoses in both sexes.
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Machón M, Basterretxea M, Martínez-Camblor P, Aldasoro E, San Vicente JM, Larrañaga N. Diferencias por sexo en la supervivencia relativa y los factores pronósticos de pacientes con un primer infarto agudo de miocardio en Guipúzcoa. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70157-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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APACHE-II score and Killip class for patients with acute myocardial infarction. Intensive Care Med 2010; 36:1579-86. [PMID: 20333355 DOI: 10.1007/s00134-010-1832-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 01/09/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse the influence on the prognosis of intensive care unit (ICU) patients with acute myocardial infarction (AMI): prognostic index score, Killip class, AMI site, thrombolysis and other variables that might improve prognostic capacity and functioning of the APACHE-II index. DESIGN Cohort study using prospectively gathered ARIAM project data. SETTING ICUs from 129 Spanish hospitals. PATIENTS ICU-admitted AMI patients in ARIAM database during 4-year period were retrospectively studied. MEASUREMENTS AND MAIN RESULTS The sample comprised 6,458 patients, 76.8% males, age 64.97 +/- 12.56 years, APACHE-II score 9.49 +/- 7.03 points and ICU mortality 8.9%. Mortality was higher for females (p < 0.001), anterior AMI site (p < 0.001), previous AMI (p < 0.001), delay-to-hospital arrival >180 min (p = 0.003) and non-receipt of thrombolysis (p = 0.015). ICU mortality was related to age (p < 0.001) and APACHE-II score (p < 0.001). In multivariate analysis, it was related to APACHE-II (OR 1.16), age (OR 1.05), gender (OR 1.64), previous AMI (OR 1.57), anterior AMI (OR 2.05) and delay >180 min (OR 1.37). Killip class, gathered in 1,893 patients, was significantly associated with ICU mortality, and two predictive models were constructed for this group using multivariate analysis. Area under ROC curve was 0.94 in one (Killip class, age, gender, APACHE-II) versus 0.92 in the other (same variables without APACHE-II). CONCLUSIONS APACHE-II score and Killip class are useful for assessing the severity of patients with AMI and are complementary. Each can be used with a few commonly gathered clinical variables to construct prognostic models to assess severity. Their joint application yields a model with excellent discrimination capacity.
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