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Jang SJ, Kim LK, Sobti NK, Yeo I, Cheung JW, Feldman DN, Amin NP, Narotsky DL, Goyal P, McCullough SA, Krishnan U, Zarich S, Wong SC, Kim SM. Mortality of patients with ST-segment-elevation myocardial infarction without standard modifiable risk factors among patients without known coronary artery disease: Age-stratified and sex-related analysis from nationwide readmissions database 2010-2014. Am J Prev Cardiol 2023; 14:100474. [PMID: 36923367 PMCID: PMC10009437 DOI: 10.1016/j.ajpc.2023.100474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The proportion of ST-segment elevation myocardial infarction (STEMI) patients without standard modifiable risk factors (SMuRFs: hypertension, diabetes, hypercholesterolemia and smoking) has increased over time. The absence of SMuRFs is known to be associated with worse outcomes, but its association with age and sex is uncertain. We sought to evaluate the association between age and sex with the outcomes of post-STEMI patients without SMuRFs among patients without preexisting coronary artery disease. Methods Patients who underwent primary PCI for STEMI were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, in-hospital, and 30-day outcomes in patients with or without SMuRFs were compared in men versus women and stratified into five age groups. Results Between January 2010 and November 2014, of 474,234 patients who underwent primary PCI for STEMI, 52,242 (11.0%) patients did not have SMuRFs. Patients without SMuRFs had higher in-hospital mortality rates than those with SMuRFs. Among those without SMuRFs, the in-hospital mortality rate was significantly higher in women than men (10.6% vs 7.3%, p<0.001), particularly in older age groups. The absence of SMuRFs was associated with higher 30-day readmission-related mortality rates (0.5% vs 0.3% with SMuRFs, p<0.001). Among patients without SMuRFs, women had a higher 30-day readmission-related mortality rates than men (0.6% vs 0.4%, p<0.001). After multivariable adjustment, the increased rates of in-hospital (odds ratio 1.89 (95% CI 1.72 to 2.07) and 30-day readmission-related mortality (hazard ratio 1.30 (95% CI 1.01 to 1.67)) in patients without SMuRFs remained significant. Conclusions STEMI patients without SMuRFs have a significantly higher risk of in-hospital and 30-day mortality than those with SMuRFs. Women and older patients without SMuRFs experienced significantly higher in-hospital and 30-day readmission-related mortality.
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Affiliation(s)
- Sun-Joo Jang
- Department of Medicine, Yale New Haven Health/Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, United States
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Luke K. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Navjot Kaur Sobti
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Ilhwan Yeo
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Jim W. Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Dmitriy N. Feldman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Nivee P. Amin
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
- Weill Cornell Medicine Women's Heart Program, Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - David L. Narotsky
- Division of Cardiology, Yale New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States
| | - Parag Goyal
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, United States
| | - S. Andrew McCullough
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Udhay Krishnan
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Stuart Zarich
- Division of Cardiology, Yale New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States
| | - S. Chiu Wong
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
| | - Samuel M. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, United States
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Acute Coronary Syndrome in Women. Emerg Med Clin North Am 2022; 40:629-636. [DOI: 10.1016/j.emc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Solinas E, Alabrese R, Cattabiani MA, Grassi F, Pelà GM, Benatti G, Tadonio I, Toselli M, Ardissino D, Vignali L. Spontaneous coronary artery dissection: an Italian single centre experience. J Cardiovasc Med (Hagerstown) 2022; 23:141-148. [PMID: 34570037 DOI: 10.2459/jcm.0000000000001256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute myocardial infarction (AMI) in young women without a typical cardiovascular risk profile. Knowledge on SCAD is based on observational studies and is still scarce. The aim of this monocentric observational study was to evaluate the predisposing factors, clinical features and prognosis of SCAD patients. METHODS Between 2013 and 2020, 58 patients with angiographic diagnosis of SCAD were identified in our centre with an overall prevalence of 0.9% among patients admitted for AMI (58 of 6414 patients). RESULTS The mean age was 54 ± 11 years and the majority were women (n = 50, 86%) with one or fewer cardiovascular risk factors (n = 35, 60%). The prevalence of Fibromuscolar Dysplasia (FMD) was 39% (7 of 18 screened patients). The rate of major adverse cardiovascular and cerebrovascular events (MACCEs) was used to assess the prognosis. Out-of-hospital cardiac arrest because of ventricular fibrillation was observed in four (7%) patients. The majority of patients (n = 51, 88%) were treated conservatively without revascularization. The in-hospital and 30-day clinical course was uneventful in most patients (n = 54, 93%) with two cardiac deaths. During a median follow-up of 12 months, there were no further deaths. The global rate of SCAD recurrence was significant (n = 8, 14%) but predictors have not been identified. CONCLUSION Although overall survival seems good, SCAD is a potentially malignant, not rare disease, which can present with sudden cardiac death and not uncommon recurrence. Prognostic stratification and optimal management of SCAD patients remain to be defined.
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Affiliation(s)
- Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma
| | | | | | | | | | | | - Iacopo Tadonio
- Division of Cardiology, Parma University Hospital, Parma
| | - Marco Toselli
- GVM Care and Research, Maria Cecilia Hospital, Interventional Cardiology Unit Cotignola, Ravenna, Italy
| | | | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, Parma
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Díez-Villanueva P, García-Guimaraes MM, Macaya F, Masotti M, Nogales JM, Jimenez-Kockar M, Velázquez M, Lozano Í, Moreu J, Avanzas P, Salamanca J, Alfonso F. Spontaneous Coronary Artery Dissection and Menopause. Am J Cardiol 2021; 148:53-59. [PMID: 33617813 DOI: 10.1016/j.amjcard.2021.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 01/28/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome in women. The role of sexual hormones has been related to the pathophysiology of SCAD. However, clinical features, angiographic findings, management and outcomes of SCAD women in relation to menopause status remain unknown. The Spanish multicenter prospective SCAD registry (NCT03607981), included 318 consecutive patients with SCAD. All coronary angiograms were analyzed in a centralized Corelab. In this substudy, 245 women were classified according to their menopause state (pre-menopausal and post-menopausal). In-hospital outcomes were analyzed: 148 patients (60.4%) were post-menopausal. These patients were older (57 [52 to 66] vs 49 [44 to 54] years, p <0.01) and had more often hypertension (49% vs 27%, p <0.01) and dyslipidemia (46% vs 25%, p <0.01). Post-menopausal women showed more often previous history of acute coronary syndrome, including previous SCAD (9% vs 3%, p = 0.046), and presented less frequently as ST-segment elevation myocardial infarction on admission, compared with premenopausal women (34% vs 49%, p = 0.014). On the other hand, premenopausal women showed more often proximal and multisegment involvement (24% vs 7%, and 32% vs 18%, respectively, both p <0.01). Post-menopausal women were more often managed conservatively (85% vs 71%, p <0.01) and presented less frequently left ventricular dysfunction (both, p <0.01). There were no differences between groups in terms of in-hospital stay or mortality, new acute myocardial infarction, unplanned coronary angiography or heart failure. In conclusion, post-menopausal women with SCAD show different clinical and angiographic characteristics compared with pre-menopausal SCAD patients. Initial treatment strategy was different between groups, though in-hospital outcomes did not significantly differ (NCT03607981).
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología. Hospital Universitario de La Princesa, Madrid. Spain, CIBER-CV, IIS-IP, Universidad Autónoma de Mdrid, Spain
| | - Marcos Manuel García-Guimaraes
- Servicio de Cardiología. Hospital del Mar - Parc de Salut Mar, Barcelona. Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología. Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid. Spain
| | - Mónica Masotti
- Servicio de Cardiología. Hospital Clinic de Barcelona, Barcelona. Spain
| | | | | | - Maite Velázquez
- Servicio de Cardiología. Hospital Universitario 12 de Octubre, Madrid, Spain. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España. CIBERCV
| | - Íñigo Lozano
- Servicio de Cardiología. Hospital Universitario de Cabueñes, Gijón. Spain
| | - Jose Moreu
- Servicio de Cardiología. Hospital General Universitario de Toledo, Toledo, Spain
| | - Pablo Avanzas
- Servicio de Cardiología. Hospital Universitario Central de Asturias. Oviedo. Spain. Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain, University of Oviedo, Oviedo, Spain
| | - Jorge Salamanca
- Servicio de Cardiología. Hospital Universitario de La Princesa, Madrid. Spain, CIBER-CV, IIS-IP, Universidad Autónoma de Mdrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología. Hospital Universitario de La Princesa, Madrid. Spain, CIBER-CV, IIS-IP, Universidad Autónoma de Mdrid, Spain.
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Mehilli J, Presbitero P. Coronary artery disease and acute coronary syndrome in women. Heart 2020; 106:487-492. [PMID: 31932287 DOI: 10.1136/heartjnl-2019-315555] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022] Open
Abstract
There are important dissimilarities in clinical presentation, aggregation of comorbidities, cardiovascular risk factors and the quality of delivery of medical care among men and women with acute coronary syndrome (ACS). Compared with men, despite the well-known older age and more pronounced frailty, women with ACS present later from symptom onset and are at high bleeding risk after invasive procedures. In addition, autoimmune/inflammatory disease, fibromuscular dysplasia, polycystic ovary, early menopause and history of pre-eclampsia are risk factors preceding ACS among younger women. They more often experience myocardial infarction in the absence of obstructive coronary arteries (MINOCA), which makes diagnosis and treatment of ACS among women more challenging compared with men. Women and men do both benefit from guideline-recommended treatment, although, compared with men, women with ACS have a higher adjusted risk of early death, which equalises between both sexes within the first year. Young women with ACS suffer frequently of depression and present often with MINOCA. Compared with young men, they (young women) have a higher risk of death. Therefore, focusing on young patients with ACS, understanding the particular physiopathology of MINOCA and developing programmes targeting comorbidities and depression-related behavioural risk factors are urgently needed.
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Affiliation(s)
- Julinda Mehilli
- Cardiology, University Hospital Munich, Munchen, Germany .,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany, Munich, Germany
| | - Patrizia Presbitero
- U.O. Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milano, Italy
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Hart K, Patel S, Kovoor J. Spontaneous Coronary Artery Dissection Associated with Anal Cancer Management with Fluorouracil and Radiotherapy. Cureus 2019; 11:e4979. [PMID: 31467813 PMCID: PMC6706264 DOI: 10.7759/cureus.4979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is thought to be a rare condition that is hard to predict due to the lack of easily identifiable warning signs. We report the case of a 49-year-old woman with a locally advanced Stage IIIB anal squamous cell carcinoma who presented with chest pain and a positive stress test, ST elevations in her inferior echocardiogram leads, and induced chest pain with exercise without heart perfusion defects. Coronary catheterization revealed a right coronary artery dissection, which led to the diagnosis of SCAD. Our patient was diagnosed while undergoing a combination treatment of fluorouracil (5-FU), mitomycin, and pelvic radiotherapy. We reviewed the current literature and update the etiologies that have been proposed since the publication of this case report.
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Affiliation(s)
- Kimberly Hart
- Radiation Oncology, The Karmanos Cancer Center's Gershenson Radiation Oncology Center, Wayne State University School of Medicine, Detroit, USA
| | - Suketu Patel
- Radiation Oncology, The Karmanos Cancer Center's Gershenson Radiation Oncology Center, Wayne State University School of Medicine, Detroit, USA
| | - Joshua Kovoor
- Radiation Oncology, The Karmanos Cancer Center's Gershenson Radiation Oncology Center, Wayne State University School of Medicine, Detroit, USA
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Abstract
Heart disease is the leading cause of death among women in the industrialized world. However, women after myocardial infarctions (MIs) are less likely to receive preventive medications or revascularization and as many as 47% experience heart failure, stroke or die within 5 years. Premenopausal women with MIs frequently have coronary plaque erosions or dissections. Women under 50 years with angina and nonobstructive epicardial coronary artery disease often have coronary microvascular dysfunction (CMD) with reductions in coronary flow reserve that may require nontraditional therapies. In women with coronary artery disease treated with stents, the 3-year incidence of recurrent MI or death is 9.2%. Coronary bypass surgery operative mortality averages 4.6% for women compared with 2.4% in men. Addition of internal mammary artery and radial artery coronary grafts in women does not increase operative survival but improves 5-year outcome to greater than 80%.
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CME Opportunities and Save the Date. Vasc Med 2017; 22:554-555. [PMID: 29202679 DOI: 10.1177/1358863x17737423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Eyre A, Epino H, Bhatia K, Miller ES. A Young Man with Acute Chest Pain. J Emerg Med 2017; 53:749-752. [PMID: 28987301 DOI: 10.1016/j.jemermed.2017.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Andrew Eyre
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Henry Epino
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kriti Bhatia
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily Senecal Miller
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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