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Fischer AJ, Feld J, Lange SA, Günster C, Dröge P, Engelbertz C, Ruhnke T, Gerß J, Reinecke H, Köppe J. Impact of Guideline-Directed Drug Therapy after ST-Elevation Myocardial Infarction on Outcome in Young Patients-Age and Sex-Specific Factors. J Clin Med 2024; 13:3788. [PMID: 38999354 PMCID: PMC11242167 DOI: 10.3390/jcm13133788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Specifically young women are at risk for a poor outcome after ST-elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in outcome and associate these results with adherence to a guideline-directed optimal medical therapy (OMT). Methods: Administrative insurance data (≈26 million insured) were screened for patients aged 18-60 years with STEMI. Patient demographics, details on in-hospital treatment, adherence to OMT and its effect on mortality were assessed. Adherence to OMT was analyzed using multistate models and an association of those with death was fitted using multivariable Cox regression models with time-dependent co-variables. Results: Overall, 59,401 patients (19.3% women), median age 52 (interquartile range 48, 56) presented with STEMI. Female sex was associated with a poor outcome early after STEMI (90-day mortality: odds ratio 1.22, 95% confidence interval (CI) 1.12-1.32, p < 0.001). Overall survival was reduced in women compared to same-aged men. The ten-year survival rate was 19.7% (18.1-21.2%) versus 19.6% (18.9-20.4%) in men (p < 0.001). Although long-term drug adherence was low, its intake was associated with a better outcome. Specifically younger women showed a markedly lower mortality when on OMT (hazard ratio (HR) 0.22 (95% CI 0.19-0.26) versus HR 0.31 (95% CI 0.28-0.33) in men, pint < 0.001). Conclusions: Specifically young women were at risk for a poor outcome in the early phase after STEMI. Although long-term adherence to OMT was low, it was generally associated with a lower mortality, specifically in women. Our findings emphasize on early and long-term preventive measures in all patients after STEMI.
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Affiliation(s)
- Alicia Jeanette Fischer
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease University Hospital Muenster, 48149 Muenster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Stefan A Lange
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany
| | | | - Patrik Dröge
- AOK Research Institute (WIdO), 10178 Berlin, Germany
| | - Christiane Engelbertz
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany
| | - Thomas Ruhnke
- AOK Research Institute (WIdO), 10178 Berlin, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
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Earle NJ, Doughty RN, Devlin G, White H, Riddell C, Choi Y, Kerr AJ, Poppe KK. Sex differences in outcomes after acute coronary syndrome vary with age: a New Zealand national study. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:284-292. [PMID: 38085048 PMCID: PMC10927026 DOI: 10.1093/ehjacc/zuad151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 03/13/2024]
Abstract
AIMS This study investigated age-specific sex differences in short- and long-term clinical outcomes following hospitalization for a first-time acute coronary syndrome (ACS) in New Zealand (NZ). METHODS AND RESULTS Using linked national health datasets, people admitted to hospital for a first-time ACS between January 2010 and December 2016 were included. Analyses were stratified by sex and 10-year age groups. Logistic and Cox regression were used to assess in-hospital death and from discharge the primary outcome of time to first cardiovascular (CV) readmission or death and other secondary outcomes at 30 days and 2 years. Among 63 245 people (mean age 69 years, 40% women), women were older than men at the time of the ACS admission (mean age 73 vs. 66 years), with a higher comorbidity burden. Overall compared with men, women experienced higher rates of unadjusted in-hospital death (10% vs. 7%), 30-day (16% vs. 12%) and 2-year (44% vs. 34%) death, or CV readmission (all P < 0.001). Age group-specific analyses showed sex differences in outcomes varied with age, with younger women (<65 years) at higher risk than men and older women (≥85 years) at lower risk than men: unadjusted hazard ratio of 2-year death or CV readmission for women aged 18-44 years = 1.51 [95% confidence interval (CI) 1.21-1.84] and aged ≥85 years = 0.88 (95% CI 0.83-0.93). The increased risk for younger women was no longer significant after multivariable adjustment whereas the increased risk for older men remained. CONCLUSION Men and women admitted with first-time ACS have differing age and comorbidity profiles, resulting in contrasting age-specific sex differences in the risk of adverse outcomes between the youngest and oldest age groups.
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Affiliation(s)
- Nikki J Earle
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
- Cardiology, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
| | - Gerry Devlin
- Cardiology, Gisborne Hospital, Gisborne, New Zealand
| | - Harvey White
- Cardiology, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
| | - Craig Riddell
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
| | - Yeunhyang Choi
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Katrina K Poppe
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
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Qalby N, Arsyad DS, Qanitha A, Cramer MJ, Appelman Y, Pabittei DR, Doevendans PA, Mappangara I, Muzakkir AF. In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia. BMC Health Serv Res 2024; 24:284. [PMID: 38443913 PMCID: PMC10916244 DOI: 10.1186/s12913-024-10637-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS). METHODS This is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis. RESULTS We observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001). CONCLUSIONS This study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.
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Affiliation(s)
- Nurul Qalby
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Dian S Arsyad
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Andriany Qanitha
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Cardiovascular Sciences, Amsterdam UMC Location VUMC, Amsterdam, the Netherlands
| | - Dara R Pabittei
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Cardiothoracic Surgery, AMC Heart Center, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Akhtar Fajar Muzakkir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
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Krackhardt F, Yan G, Kherad B, Blaich B, Leschke M, Waliszewski M. The effect of gender on clinical outcomes following routine revascularizations with polymer-free sirolimus-eluting stents. Coron Artery Dis 2024; 35:1-7. [PMID: 37990553 DOI: 10.1097/mca.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Gender-specific outcomes after percutaneous coronary interventions were studied by a number of research groups with different endpoints and cohorts of different ethnic extractions. The purpose of this report is to use propensity score matching to determine gender-specific differences in clinical outcomes after percutaneous coronary interventions with polymer-free sirolimus-coated stents. MATERIALS AND METHODS The basis for this post hoc analysis was two large all-comers studies with prospectively enrolled patients from Europe and Asia. Data were pooled and analyzed in terms of clinical outcomes to assess the impact of gender in patients with stable coronary artery disease and acute coronary syndrome. The primary endpoint was the accumulated target-lesion revascularization rate whereas secondary endpoints consisted of the event rates for major adverse cardiac events (MACE), myocardial infarction, bleeding events and death from all causes. The purpose of these post hoc analyses was to detect potential differences in clinical outcomes between females and males in unselected and propensity-score-matched cohorts. RESULTS Overall, in the unmatched cohorts, accumulated target-lesion revascularization rates did not differ between both genders (2.7% vs. 2.0%; P = 0.101), however, accumulated MACE rates were higher in females than in males (5.2% vs. 3.9%; P = 0.020). After propensity-score-matching, primarily adjusting for age, hypertension and diabetes, our data revealed similar accumulated MACE in women and men (5.5% vs. 5.2%; P = 0.749). In the unmatched STEMI subgroup, all-cause mortality was significantly higher in females driven by older age ( P < 0.001). CONCLUSION In the propensity-score-matched real-world cohorts, female gender was not a predictor for increased rates of accumulated MACE. In the unmatched STEMI subgroup, all-cause mortality was significantly higher in females due to older age. Age seems to be the determining factor for increased clinical event rates and not gender.
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Affiliation(s)
- Florian Krackhardt
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz
- Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz
| | - Guangyao Yan
- Medical Scientific Affairs, B.Braun Melsungen AG, Sieversufer
| | - Behrouz Kherad
- Charité Universitätsmedizin, Internal Medicine and Cardiology, Campus Virchow, Department of Cardiology, Augustenburger Platz, Berlin
| | - Birgit Blaich
- Klinikum Esslingen, Kardiologie, Angiologie und Pneumologie, Esslingen, Germany
| | - Matthias Leschke
- Klinikum Esslingen, Kardiologie, Angiologie und Pneumologie, Esslingen, Germany
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Kuno T, Miyamoto Y, Sawano M, Kodaira M, Numasawa Y, Ueda I, Suzuki M, Noma S, Fukuda K, Kohsaka S. Gender Differences in Long-Term Outcomes of Young Patients Who Underwent Percutaneous Coronary Intervention: Long-Term Outcome Analysis from a Multicenter Registry in Japan. Am J Cardiol 2023; 206:151-160. [PMID: 37703680 DOI: 10.1016/j.amjcard.2023.08.106] [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: 07/05/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
Young patients who underwent percutaneous coronary intervention (PCI) have shown worse long-term outcomes but remain inadequately investigated. We analyzed 1,186 consecutive young patients (aged ≤55 years) from the Keio Cardiovascular PCI registry who were successfully discharged after PCI (2008 to 2019) and compared them to 5,048 older patients (aged 55 to 75 years). The primary outcome was a composite of all-cause death, acute coronary syndrome, heart failure, bleeding, stroke requiring admission, and coronary artery bypass grafting within 2 years after discharge. In the young patients, the mean age was 48.4 ± 5.4 years, acute coronary syndrome cases accounted for 69.6%, and 92 (7.8%) were female. Body mass index; hemoglobin levels; and proportions of smoking, hyperlipidemia, and ST-elevation myocardial infarction were lower and dialysis or active cancer proportions were higher in young female patients than male patients. A higher number of young female than male patients reached the primary end point and all-cause death (15.2% vs 7.1%, p = 0.01; 4.3% vs 1.0%, p = 0.023), mainly because of noncardiac death (4.3% versus 0.5%, p = 0.001). After covariate adjustment, the primary end point rates were higher among young women than men (hazard ratio 2.00, 95% confidence interval 1.03 to 3.89, p = 0.042). Gender did not predict the primary end point among older patients (vs men; hazard ratio 0.84, 95% confidence interval 0.67 to 1.06, p = 0.14). In conclusion, young women showed worse outcomes during the 2-year post-PCI follow-up, but this gender difference was absent in patients aged 55 to 75 years.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York.
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Masaki Kodaira
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, Saitama National Hospital, Wako, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Xu M, Yang F, Shen B, Wang J, Niu W, Chen H, Li N, Chen W, Wang Q, HE Z, Ding R. A bibliometric analysis of acute myocardial infarction in women from 2000 to 2022. Front Cardiovasc Med 2023; 10:1090220. [PMID: 37576112 PMCID: PMC10416645 DOI: 10.3389/fcvm.2023.1090220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/01/2023] [Indexed: 08/15/2023] Open
Abstract
Background Plenty of publications had been written in the last several decades on acute myocardial infarction (AMI) in women. However, there are few bibliometric analyses in such field. In order to solve this problem, we attempted to examine the knowledge structure and development of research about AMI in women based on analysis of related publications. Method The Web of Science Core Collection was used to extract all publications regarding AMI in women, ranging from January 2000 to August 2022. Bibliometric analysis was performed using VOSviewer, Cite Space, and an online bibliometric analysis platform. Results A total of 14,853 publications related to AMI in women were identified from 2000 to 2022. Over the past 20 years, the United States had published the most articles in international research and participated in international cooperation the most frequently. The primary research institutions were Harvard University and University of Toronto. Circulation was the most cited journal and had an incontrovertible academic impact. 67,848 authors were identified, among which Harlan M Krumholz had the most significant number of articles and Thygesen K was co-cited most often. And the most common keywords included risk factors, disease, prognosis, mortality, criteria and algorithm. Conclusion The research hotspots and trends of AMI in women were identified and explored using bibliometric and visual methods. Researches about AMI in women are flourishing. Criteria and algorithms might be the focus of research in the near future, which deserved great attentions.
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Affiliation(s)
- Ming Xu
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
- Department of Cardiology, Shanghai Navy Feature Medical Center, Naval Medical University, Shanghai, China
| | - Fupeng Yang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Bin Shen
- Department of Cardiology, Shanghai Navy Feature Medical Center, Naval Medical University, Shanghai, China
| | - Jiamei Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Wenhao Niu
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Hui Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Na Li
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Wei Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Qinqin Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Zhiqing HE
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
| | - Ru Ding
- Department of Cardiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Shanghai Cardiovascular Institute of Integrative Medicine, Shanghai, China
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Babu Pothineni R, Ajmera P, Chawla KK, Mantravadi SS, Pathak A, Inamdar MK, Jariwala PV, Vijan V, Vijan V, Potdar A. Ultrathin Strut Biodegradable Polymer-Coated Sirolimus-Eluting Coronary Stents: Patient-Level Pooled Analysis From Two Indian Registries. Cureus 2023; 15:e41743. [PMID: 37575772 PMCID: PMC10415628 DOI: 10.7759/cureus.41743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Background Despite significant evolution in stent technology, female gender, and patients with diabetes mellitus, multivessel disease, total occlusions, long lesions, and small vessels represent the "Achilles' heel" of contemporary percutaneous coronary intervention (PCI). We performed a pooled analysis of high-risk subgroup on patient-level data from the T-Flex registry (1,203 patients) and a real-world Indian registry (1,269 patients), with the aim of assessing one-year safety and clinical performance of ultrathin strut biodegradable polymer-coated Supra family of sirolimus-eluting stents (SES) (Sahajanand Medical Technologies Limited, Surat, India) in the real-world, all-comer population. Method We pooled the following high-risk subgroups data from two all-comer registries: female gender (n=678), diabetes mellitus (n=852), multivessel disease (n=406), total occlusions (n=420), long lesions (≥28 mm) (n=1241), and small vessels (≤2.5 mm) (n=726). Both the registries included patients with coronary artery disease who underwent implantation of at least one SES belonging to the Supra family of stents from May 2016 until March 2018, irrespective of lesion complexity and comorbidities. The primary endpoint was the inci-dence of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revas-cularization by percutaneous or surgical methods up to one year. The safety endpoint was stent thrombosis. Results According to prespecified high-risk subgroups, one-year rates of TLF and overall stent thrombosis, respectively, were as follows: female gender (4.9% and 0.6%), diabetes mellitus (6.9% and 1.0%), multivessel disease (6.4% and 0.8%), total occlusions (5.2% and 0.5%), long lesions (≥28 mm) (6.6% and 0.8%), and small vessels (≤2.5 mm) (6.1% and 1.3%). Conclusion This present pooled analysis demonstrated the one-year safety and clinical performance of ultrathin strut biodegradable polymer-coated Supra family of SES in a real-world, all-comer population, with considerably low rates of TLF and stent thrombosis.
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Affiliation(s)
| | - Prakash Ajmera
- Cardiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad, IND
| | - Kamal Kumar Chawla
- Cardiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad, IND
| | | | - Abhijit Pathak
- Cardiology, Swasthya Hospital and Medical Research Centre, Ahmednagar, IND
| | | | | | - Vikrant Vijan
- Cardiology, Vijan Cardiac and Critical Care Centre, Nashik, IND
| | - Vinod Vijan
- Cardiology, Vijan Cardiac and Critical Care Centre, Nashik, IND
| | - Anil Potdar
- Cardiology, Parisoha Foundation Pvt. Ltd, Mumbai, IND
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8
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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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9
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Weizman O, Tea V, Marijon E, Eltchaninoff H, Manzo-Silberman S, Leclercq F, Albert F, Bataille V, Drouet E, Naccache N, Puymirat E, Ferrières J, Schiele F, Simon T, Danchin N. Very long-term outcomes after acute myocardial infarction in young men and women: Insights from the FAST-MI program. Arch Cardiovasc Dis 2023; 116:324-334. [PMID: 37391340 DOI: 10.1016/j.acvd.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
AIMS Conflicting data exists about long-term outcomes in young women and men experiencing acute myocardial infarction (AMI). METHODS The FAST-MI program consists of three nationwide French surveys carried out 5years apart from 2005 to 2015, including consecutive patients with AMI over a 1-month period with up to 10-year follow-up. The present analysis focused on adults≤50 yo according to their gender. RESULTS Women accounted for 17.5% (335) of the 1912 patients under 50 yo and had a similar age as men (43.9±5.1 vs. 43.9±5.5years, P=0.92). They received less percutaneous coronary interventions (PCI) than men (85.9% vs. 91.3%, P=0.005), even in ST-elevation myocardial infarction (83.6% vs. 93.5%, P<0.001). Recommended secondary prevention medications were less frequently prescribed at discharge in women (40.6% vs. 52.8%, P<0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, P<0.001). Still, ten-year survival was similar in men (90.5%) and women (92.3%) (crude HR: 0.86 [95% CI: 0.55-1.35], P=0.52, adjusted HR: 0.63 [95% CI: 0.38-1.07], P=0.09); similar results were found for ten-year survival among hospital survivors (91.2% in men vs. 93.7% in women, adjusted HR: 0.87 [95% CI: 0.45-1.66], P=0.66). Of the 1684 patients alive at hospital discharge with morbidity follow-up≥6months available, death, AMI or stroke at 8years occurred in 12.9% men and 11.2% in women (adjusted HR: 0.90 [95% CI: 0.60-1.33], P=0.59). CONCLUSIONS Young women with AMI undergo less cardiac interventions and are less often prescribed secondary prevention treatment than men, even when significant coronary artery disease is present, but keep a similar long-term prognosis after AMI. Optimal management of these young patients, regardless of gender, is necessary to ensure best outcomes after this major cardiovascular event.
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Affiliation(s)
- Orianne Weizman
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Victoria Tea
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Eloi Marijon
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Hélène Eltchaninoff
- Normandie Université, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - Stéphane Manzo-Silberman
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne Université, ACTION Study Group, Paris, France
| | - Florence Leclercq
- Centre Hospitalier Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | | | - Vincent Bataille
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Elodie Drouet
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | | | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Jean Ferrières
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - François Schiele
- University Hospital Jean-Minjoz, Department of Cardiology, Besançon, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France.
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10
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Elzeneini M, Betageri O, Kamisetty SR, Assaf Y, Elgendy IY, Shah KB. Utilization Rate and Outcomes of Intravascular Imaging in Elderly Patients Presenting With ST-Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:90-95. [PMID: 35970702 DOI: 10.1016/j.carrev.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Elderly patients presenting with ST-elevation myocardial infarction (STEMI) represent a vulnerable population with comorbid conditions and complex coronary anatomy. We aimed to describe the utilization rate and outcomes of intravascular imaging to guide percutaneous coronary intervention (PCI) in this population. METHODS The Nationwide Readmissions Database was queried for all hospitalizations for STEMI involving PCI from 2018 to 2019. Hospitalizations were stratified by patient age into a younger cohort <75 years (mean age 58.7 ± 9.5 years) and an older cohort ≥75 years. Propensity score-weighed regression analysis was used to identify the association of intravascular imaging with in-hospital mortality, 90-day all-cause readmission, and readmission for myocardial infarction (MI). RESULTS A total of 299,619 STEMI PCI hospitalizations were included. Intravascular imaging was utilized less frequently in the older cohort (6.8 % vs 7.8 %, odds ratio [OR] 0.87, 95 % CI 0.82-0.92, p < 0.001). In both cohorts, intravascular imaging was more likely to be used with anterior STEMI, complex PCI, mechanical support, and thrombectomy. Propensity score analysis showed the use of intravascular imaging was associated with lower in-hospital mortality in both cohorts (OR 0.60, 95 % CI 0.52-0.68, p < 0.001 in the younger cohort and OR 0.61, 95 % CI 0.51-0.72, p < 0.001 in the older cohort). There was no difference in 90-day all-cause readmission or readmission for MI with intravascular imaging. CONCLUSIONS Intravascular imaging during STEMI PCI is associated with lower in-hospital mortality regardless of age. Further studies are needed to understand the low utilization rates especially among elderly patients.
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Affiliation(s)
- Mohammed Elzeneini
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Omkar Betageri
- Division of Cardiovascular Medicine, Maine Medical Center, Portland, ME, United States of America
| | - Sujay R Kamisetty
- Department of Internal Medicine, University of Florida, Gainesville, FL, United States of America
| | - Yazan Assaf
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, United States of America
| | - Khanjan B Shah
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
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11
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Lunova T, Komorovsky R, Klishch I. Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Curr Cardiol Rev 2023; 19:e300622206530. [PMID: 35786190 PMCID: PMC10201882 DOI: 10.2174/1573403x18666220630120259] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS), with respect to treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS. METHODS We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately. RESULTS Women with ACS more often experienced delays in treatment compared to men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs. CONCLUSION Women with ACS experience a delay in time to treatment more often than men. They are also less likely to be treated invasively. Females have shown worse crude short-and long-term all-cause mortality compared to males. However, after adjustment for multiple covariates, a less significant gender difference has been observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations on gender-related influence of particular risk factors on the outcomes of ACS.
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Affiliation(s)
- Tetiana Lunova
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Roman Komorovsky
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Ivan Klishch
- Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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12
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Clinical Outcomes in Younger Women Hospitalized With an Acute Myocardial Infarction: A Contemporary Population-Level Analysis. Can J Cardiol 2022; 38:1651-1660. [PMID: 36334935 DOI: 10.1016/j.cjca.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND For younger women with acute myocardial infarction (AMI), little is known regarding their contemporary care pathways and clinical outcomes. METHODS We studied AMI patients aged 18-55 years, hospitalized from April 1, 2009, to March 31, 2019, in Ontario, Canada. We compared trends in comorbidities, angiographic findings, and revascularisation rates in men and women. The primary outcome was 1-year all-cause mortality or readmission for unstable angina, AMI, heart failure, or stroke. Inverse probability of treatment weighting was used to account for differences in baseline clinical characteristics between men and women. RESULTS Among the 38,071 AMI patients included, 8,077 (21.2%) were women. Over the study period, women had increasing rates of diabetes (24.8% to 34.9%; Ptrend < 0.001), and declining rates of smoking (53.2% to 41.7%; Ptrend < 0.005). Although most patients received coronary angiography (96%), coronary revascularisation was less frequent among women than men (percutaneous coronary intervention: 61.9% vs 78.8% [P < 0.001]; surgery: 4.1% vs 6.0% [P < 0.001]). Women had more normal coronary anatomy (5.8% vs 1.7%; P < 0.001) and nonobstructive disease (22.8% vs 9.3%; P < 0.001) than men. Compared with men, the primary composite end point was significantly increased among women (10.0% vs 7.9%, adjusted HR 1.11; P = 0.02) and related to increased readmission rates for cardiovascular events. All-cause readmission was significantly increased among women (25.8% vs 21.1%, adjusted HR 1.34; P < 0.0001). CONCLUSIONS Coronary angiography is performed almost universally in younger women with AMI; however, coronary revascularisation is less frequent, perhaps reflecting less obstructive disease. Although mortality rates after AMI were similar between sexes, cardiovascular readmission rates and all-cause readmissions were significantly increased among women.
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13
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Larsen AI, Løland KH, Hovland S, Bleie Ø, Eek C, Fossum E, Trovik T, Juliebø V, Hegbom K, Moer R, Larsen T, Uchto M, Rotevatn S. Guideline-Recommended Time Less Than 90 Minutes From ECG to Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Is Associated with Major Survival Benefits, Especially in Octogenarians: A Contemporary Report in 11 226 Patients from NORIC. J Am Heart Assoc 2022; 11:e024849. [PMID: 36056722 PMCID: PMC9496403 DOI: 10.1161/jaha.122.024849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Using contemporary data from NORIC (Norwegian Registry of Invasive Cardiology) we investigated the predictive value of patient age and time from ECG diagnosis to sheath insertion (ECG‐2‐sheath) in primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction (STEMI). Methods and Results Data from 11 226 patients collected from all centers offering 24/7/365 primary percutaneous coronary intervention service were explored. For patients aged <80 years the mortality rates were 5.6% and 7.6% at 30 days and 1 year, respectively. For octogenarians the corresponding rates were 15.0% and 24.2%. The Cox hazard ratio was 2.02 (1.93–2.11, P value <0.0001) per 10 years of patient age. Time from ECG‐2‐sheath was significantly associated with mortality with a 3.6% increase per 30 minutes of time. Using achievement of time goal <90 minutes in patients aged >80 years and mortality at 30 days, mortality was 10.5% and 17.7% for <90 or ≥90 minutes, respectively. The number needed to prevent 1 death was 39 in the whole population and 14 in the elderly. Restricted mean survival gains during median 938 days of follow‐up in patients with ECG‐2‐sheath time <90 minutes were 24 and 76 days for patients aged <80 and ≥80 years, respectively. Conclusions Time from ECG‐diagnosis to sheath insertion is strongly correlated with mortality. This applies especially to octogenarians who derive the most in terms of absolute mortality reduction. Registration URL: https://helsedata.no/en/forvaltere/norwegian‐institute‐of‐public‐health/norwegian‐registry‐of‐invasive‐cardiology/.
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Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Institute of Clinical Sciences, University of Bergen Bergen Norway
| | - Kjetil Halvorsen Løland
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway.,Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Siren Hovland
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway
| | - Øyvind Bleie
- Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Christian Eek
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Eigil Fossum
- Department of Cardiology Oslo University Hospital Ullevål, Oslo Norway
| | - Thor Trovik
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Vibeke Juliebø
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Knut Hegbom
- Clinic for Heart Disease St. Olav's University Hospital Trondheim Norway
| | | | | | - Michael Uchto
- Division of Internal Medicine Nordlandssykehuset Bodø Norway
| | - Svein Rotevatn
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway
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14
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Gabani R, Spione F, Arevalos V, Grima Sopesens N, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Gender Differences in 10-Year Outcomes Following STEMI: A Subanalysis From the EXAMINATION-EXTEND Trial. JACC Cardiovasc Interv 2022; 15:1965-1973. [PMID: 36008267 DOI: 10.1016/j.jcin.2022.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether gender plays a role in very long term outcomes. OBJECTIVES The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by gender. METHODS EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to gender. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age. RESULTS Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints. CONCLUSIONS At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and gender-specific risk factor control and targeted treatment. (10-Years Follow-Up of the EXAMINATION Trial [EXAMINAT10N]; NCT04462315).
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Affiliation(s)
- Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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15
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Paradossi U, Taglieri N, Massarelli G, Palmieri C, De Caterina AR, Bruno AG, Taddei A, Nardi E, Ghetti G, Palmerini T, Trianni G, Mazzone A, Pizzi C, Donati F, Bendandi F, Marrozzini C, Ravani M, Galiè N, Saia F, Berti S. Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI. J Cardiovasc Med (Hagerstown) 2022; 23:234-241. [PMID: 35081074 DOI: 10.2459/jcm.0000000000001300] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate gender difference in mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (PPCI). METHODS We analyzed data from the prospective registries of two hub PPCI centres over a 10-year period to assess the role of female gender as an independent predictor of both all-cause and cardiac death at 30 days and 1 year. To account for all confounding variables, a propensity score (PS)-adjusted multivariable Cox regression model and a PS-matched comparison between the male and female were used. RESULTS Among 4370 consecutive STEMI patients treated with PPCI at participating centres, 1188 (27.2%) were women. The survival rate at 30 days and 1 year were significantly lower in women (Log-rank P-value < 0.001). At PS-adjusted multivariable Cox regression analysis, female gender was independently associated with an increased risk of 30-day all-cause death [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.45-3.01, P < 0.001], 30-day cardiac death (HR = 2.03;95% CI:1.41-2.93, P < 0.001), 1-year all-cause death (HR = 1.45; 95% CI:1.16-1.82, P < 0.001) and 1-year cardiac death (HR = 1.51; 95% CI:1.15-1.97, P < 0.001). For the study outcome, we found a significant interaction of gender with the multivessel disease in females who were at increased risk of mortality in comparison with men in absence of multivessel disease. After the PS matching procedure, a subset of 2074 patients were identified. Women still had a lower survival rate and survival free from cardiac death rate both at 30-day and at 1-year follow-up. CONCLUSION As compared with men, women with STEMI treated with PPCI have higher risk of both all-cause death and cardiac mortality at 30-day and 1-year follow-up.
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Affiliation(s)
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Massarelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Donati
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Bendandi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sergio Berti
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, Massa
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Alexander S, Li S, Tracy M. Cardiac rehabilitation - The answer for the second chance. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100108. [PMID: 38560078 PMCID: PMC10978207 DOI: 10.1016/j.ahjo.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 04/04/2024]
Abstract
In the United States and worldwide, the leading cause of death in females is cardiovascular disease (CVD). However, compared to males, females have overall higher mortality rates, especially within the first few years of having an acute myocardial infarction (AMI). Despite the increased awareness of CVD in females and established benefits of cardiac rehabilitation (CR) programs, there is still delayed initiation of care, under-recognition of atypical presentations of angina in females, under referral of females to CR, and under-representation of females in CVD trials. In this paper, we will investigate the barriers to female participation in CR, explore the fundamental differences in physiology between males and females, and current limitations in CVD trials where females are under-represented. Finally, we aim to provide potential methods to increase enrollment of females in CR and CR related trials.
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Affiliation(s)
- Sarah Alexander
- Community Care Network, Inc., Munster, IN, United States of America
| | - Shannon Li
- RUSH University Medical Center, Chicago, IL, United States of America
| | - Melissa Tracy
- RUSH University Medical Center, Chicago, IL, United States of America
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17
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Mathew A, Hong Y, Yogasundaram H, Nagendran J, Punnoose E, Ashraf S, Fischer L, Abdullakutty J, Pisharody S, Bainey K, Graham M. Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity Score–Matched Analysis. CJC Open 2021; 3:S71-S80. [PMID: 34993436 PMCID: PMC8712709 DOI: 10.1016/j.cjco.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results. Methods A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)–capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score–matched groups were compared. Results We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, P < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, P < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, P = 0.03). Procedural characteristics were similar between groups. Conclusions Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
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Affiliation(s)
- Anoop Mathew
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
- Corresponding author: Dr Anoop Mathew, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, 2C2 WMC, 8440 – 112 St, NW, Edmonton, Alberta T6G 2B7, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Eapen Punnoose
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | - S.M. Ashraf
- Division of Cardiology, Government Medical College Hospital, Pariyaram, Kerala, India
| | - Louie Fischer
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | | | - Sunil Pisharody
- Division of Cardiology, Elamkulam Manakkal Sankaran Memorial Co-operative Hospital and Research Centre, Perinthalmanna, Kerala, India
| | - Kevin Bainey
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
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18
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Abstract
Menopause transition marks an important phase in life when cardiovascular risk in women gradually takes an adverse turn. Although menopausal hormone therapy has gained a negative appreciation over the last decades, its value in the treatment of disabling vasomotor symptoms is still undisputed. Cardiovascular risk assessment has become a matter of precision medicine, which is helpful for safe menopausal hormone therapy prescription. With a multidisciplinary approach the current available hormone regimens can be even given to women at intermediate cardiovascular risk, when risk factors such as hypertension and dyslipidemia are adequately monitored and treated.
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Affiliation(s)
- Angela H E M Maas
- Chair Women's Cardiovascular Health Program, Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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19
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Afrouzi M, Azar FEF, Aboutorabi A, Hajahmadi M, Ebadi SJ. Mortality probabilities after revascularization and medical therapy in CAD patients under 60 years old: a meta-analysis study. Egypt Heart J 2021; 73:99. [PMID: 34735671 PMCID: PMC8568744 DOI: 10.1186/s43044-021-00225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
To estimate death probabilities after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and medical therapy (MT) in patients under 60 years old. We conducted a search systematic on PubMed, Embase, Cochrane Library, and Web of Science up to January 2021. The study included three parts. In the probabilities part (A), Comprehensive Meta-Analysis, and in the comparison parts (B and C), Review Manager was used in conducting meta-analyses. Nine studies consisting of 16,410 people with a mean age of 51.2 ± 6 years were included in the meta-analysis. Over a mean follow-up of 3.7 ± 2 years, overall mortality after CABG, PCI and MT was 3.6% (95% CI 0.021–0.061), 4.3% (95% CI 0.023–0.080) and 9.7% (95% CI 0.036–0.235), respectively. The length of follow-up periods was almost the same and did not differ much (p = 0.19). In Part B (without adjustment of baseline characteristics), 495 (4.0%) of 12,198 patients assigned to CABG died compared with 748 (4.5%) of 16,458 patients assigned to PCI (risk ratio [RR]: 0.77, 95% CI 0.50–1.20; p = 0.25). Seventy-four (3.5%) of 2120 patients assigned to CABG and 68 (4.2%) of 1621 patients assigned to PCI died compared with 103 (9.5%) of 1093 patients assigned to MT in equal follow-up periods (CABG-MT: RR 0.34; 95% CI 0.23–0.51; p < 0.002) (PCI-MT: RR 0.40; 95% CI 0.30–0.53; p = 0.02). In Part C, overall mortality after PCI in PACD patients with STEMI was higher in elderly versus young (RR 2.64; 95% CI 2.11–3.30) and is lower in men versus women (RR 0.61; 95% CI 0.44–0.83). Mortality probabilities obtained are one of the most important factors of effectiveness in the economic evaluation studies; these rates can be used to determine the cost-effectiveness of procedures in CAD patients aged < 60 years.
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Affiliation(s)
- Mohammad Afrouzi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Aboutorabi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Hajahmadi
- Cardiovascular Department, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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20
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Tavenier AH, Hermanides RS, Ottervanger JP, Belitser SV, Klungel OH, Appelman Y, van Leeuwen MAH, van 't Hof AWJ. Sex Differences in Platelet Reactivity in Patients With ST-Elevation Myocardial Infarction: A Sub-Analysis of the ON-TIME 3 Trial. Front Cardiovasc Med 2021; 8:707814. [PMID: 34671649 PMCID: PMC8520931 DOI: 10.3389/fcvm.2021.707814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Fast and adequate platelet inhibition is one of the cornerstones in the treatment of patients with ST-elevation myocardial infarction (STEMI). The aim of this analysis is to examine sex differences in platelet inhibition in the acute treatment of STEMI patients. Methods: Platelet reactivity units (PRU) and ticagrelor plasma concentrations of all patients in the ON-TIME 3 were compared according to sex. All patients were pre-treated with crushed ticagrelor, aspirin and heparin. Both univariable and multivariable analyses were performed. Results: In this sub-analysis of the ON-TIME 3 trial, 195 STEMI patients, of which 58 female patients (29.7%) and 137 male patients (70.3%), were analyzed. PRU-values immediately post-PCI were not different in females [median 135 (IQR 47-228)] compared to males [160 (IQR 40-219), P = 0.92]. Ticagrelor plasma concentrations were higher in the females at the start of primary PCI [141 ng/mL (IQR 25-491) vs. 76 ng/mL (IQR 15-245), P = 0.049] and at 6 hours post-primary PCI [495 ng/mL (IQR 283-661) vs. 321 ng/mL (IQR 196-537), P = 0.001] compared to males. However, immediately post-primary PCI and at 1-hour post-primary PCI no significant differences in ticagrelor concentrations were seen between sexes. In multivariable analysis, sex was significantly associated with ticagrelor concentration (P = 0.04), but not with PRU (P = 0.93). Conclusion: Effective platelet inhibition reached by crushed ticagrelor in STEMI patients was similar in both sexes. Females had similar or even higher ticagrelor plasma concentrations up to 6 hours post-primary PCI compared with males.
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Affiliation(s)
| | | | | | - Svetlana V Belitser
- Department of Pharmacoepidemiology, University of Utrecht, Utrecht, Netherlands
| | - Olaf H Klungel
- Department of Pharmacoepidemiology, University of Utrecht, Utrecht, Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Arnoud W J van 't Hof
- Department of Cardiology, Isala, Zwolle, Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
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21
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Wang WH, Mar GY, Wei KC, Cheng CC, Huang WC. Risk Factors and Outcomes of Heart Failure Following First-Episode of Acute Myocardial Infarction-A Case Series Study of 161,384 Cases. Healthcare (Basel) 2021; 9:healthcare9101382. [PMID: 34683062 PMCID: PMC8544413 DOI: 10.3390/healthcare9101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Heart failure (HF) is one of the important complications of acute myocardial infarction (AMI), but the epidemiology, associated risks and outcomes have not been well investigated in the era of broad use of fluoroscopy-guided angiographic intervention. Methods: We analysed 161,384 subjects who had experienced the first episode of AMI during 1 January 2000 and 31 December 2012 using the Taiwan National Health Insurance Research Database. Results: During the index AMI hospitalization, 23.6% of cases developed HF. Female, ≥65 years-old, non-ST-segment elevation type of MI, diabetes mellitus (DM), peripheral vascular occlusion disease (PAOD), chronic obstructive pulmonary disease (COPD), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF) were associated with higher risks of developing HF. HF cases had inferior survival outcomes compared to non-HF cases in both the short and long term. Among those HF patients, ≥65 years, DM, PAOD, and VT/VF were associated with worse outcomes. On the contrary, coronary reperfusion intervention and treat-to-target pharmacologic treatment were associated with favourable survival outcomes. Conclusions: HF remains common in the modern age and poses negative impacts in survival of AMI patients. It highlights that prudent prevention and early treatment of HF during AMI hospitalization is an important medical issue.
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Affiliation(s)
- Wen-Hwa Wang
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (W.-H.W.); (G.-Y.M.); (C.-C.C.)
- College of Management, I-Shou University, Kaohsiung 824, Taiwan
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Guang-Yuan Mar
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (W.-H.W.); (G.-Y.M.); (C.-C.C.)
- Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
- Superintendent, Kaohsiung Municipal United Hospital, Kaohsiung 804, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chin-Chang Cheng
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (W.-H.W.); (G.-Y.M.); (C.-C.C.)
- Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Wei-Chun Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Physical Therapy, Fooyin University, Kaohsiung 831, Taiwan
- Correspondence:
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22
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Sulaiman S, Kawsara A, Mohamed MO, Van Spall HGC, Sutton N, Holmes DR, Mamas MA, Alkhouli M. Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2021; 10:e021638. [PMID: 34533043 PMCID: PMC8649522 DOI: 10.1161/jaha.121.021638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
Background Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. Methods and Results We selected patients admitted with a principal diagnosis of ST-segment-elevation myocardial infarction in the National Inpatient Sample (2016-2018). We used propensity-score matching to calculate average treatment effects of pPCI for in-hospital mortality, major complications, length of stay, and cost. As a sensitivity analysis, we used logit models followed by a marginal command to calculate the average marginal effect. We included 413 500 weighted hospitalizations (30.7% women, 69.3% men). Women had more comorbidities except smoking and prior sternotomy. Compared with men, women were less likely to undergo angiography (81.0% versus 87.0%; adjusted odds ratio [OR], 0.77; 95% CI, 0.74-0.81; P<0.001) or pPCI (74.0% versus 82.0%; adjusted OR, 0.76; 95% CI, 0.73-0.79; P<0.001). There were no significant differences in average treatment effects of pPCI on mortality between men (-8.4% [-9.3% to -7.6%], P<0.001), and women (-9.5% [-10.8% to -8.3%], P<0.001) (P interaction=0.16). This persisted in age-stratified analyses (≥85, 65-84, 45-64, <45 years) and sensitivity analysis, excluding emergent admissions. The average treatment effects of pPCI on major complications were comparable except for acute stroke, leaving against medical advice, and palliative encounter. There were no differences in the average treatment effects of pPCI on length of stay, but the proportional increase in cost with pPCI was higher in women. Conclusions pPCI results in a comparable reduction in in-hospital mortality in men and women. Nonetheless, risk-adjusted rates of pPCI remain lower in women in contemporary US practice.
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Affiliation(s)
| | - Akram Kawsara
- Division of CardiologyWest Virginia UniversityMorgantownWV
| | - Mohamed O. Mohamed
- Keele Cardiovascular Research GroupCentre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Harriette G. C. Van Spall
- Department of MedicineDivision of CardiologyMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- ICES (Cardiovascular Research Program)McMaster UniversityHamiltonOntarioCanada
| | - Nadia Sutton
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMI
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupCentre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
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23
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Negi SI, Nandar PP, Chaffee RB. Gender disparities in ST elevation myocardial infarction: A time to bridge the gap. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 31:48-49. [PMID: 34275741 DOI: 10.1016/j.carrev.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Smita I Negi
- Section of Cardiovascular Medicine, Summa Health System, Akron, OH, USA.
| | - Phoo Pwint Nandar
- Section of Cardiovascular Medicine, Summa Health System, Akron, OH, USA
| | - Roger B Chaffee
- Department of Cardiovascular Disease, Summa Health System, Akron, OH, USA
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24
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Rayner-Hartley E, Wong GC, Fayowski C, Cairns JA, Singer J, Lee T, Sedlak T, Humphries KH, Perry-Arnesen M, Mackay M, Fordyce CB. Impact of regionalizing ST-elevation myocardial infarction care on sex differences in reperfusion times and clinical outcomes. Clin Cardiol 2021; 44:1113-1119. [PMID: 34101211 PMCID: PMC8364721 DOI: 10.1002/clc.23658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men. HYPOTHESIS Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men. METHODS 1928 patients (413 women, 21.4%) presented with an acute STEMI between June 2007 and March 2016. The population was divided into an early cohort (n = 728 patients, 2007-May 2011), and a late cohort (n = 1200 patients, June 2011-2016). The primary endpoints evaluated were reperfusion times and in-hospital outcomes. RESULTS Compared to men, women experienced significant delays in first medical contact (FMC) to arrival at the emergency room (26.0 vs. 22.0 min, p < 0.001) and FMC-to-device (109 vs. 101 min p = 0.001). Women had higher incidences of post-PCI heart failure and death compared to men (p < 0.05). Following multivariable adjustment, no mortality difference was observed for women versus men (adjusted OR; 0.82; 95% confidence interval [CI], 0.51-1.34; p = 0.433) or for early versus late cohorts (adjusted OR; 1.04; 95% CI, 0.68-1.60; p = 0.856). CONCLUSION Following STEMI regionalization, women continued to experience significantly longer reperfusion times, although there was no difference in adjusted mortality. These results highlight the ongoing disparity of STEMI care between women and men, and suggest that regionalization alone is insufficient to close sex-based care gaps.
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Affiliation(s)
- Erin Rayner-Hartley
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Cassandra Fayowski
- Division of General Internal Medicine, Western University, London, Ontario, Canada
| | - John A Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Perry-Arnesen
- Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Martha Mackay
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Alexander T, Victor SM, Jayakumaran B, Rajan S, Mullasari S A. Sex-related Differences in Outcomes for Patients With ST Elevation Myocardial Infarction (STEMI): A TN-STEMI Program Subgroup Analysis. Heart Lung Circ 2021; 30:1870-1875. [PMID: 34088626 DOI: 10.1016/j.hlc.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND ST elevation myocardial infarction (STEMI) represents a large proportion of the clinical presentation of coronary artery disease in Indian people. Owing to multiple factors contributing to the sex difference, women with STEMI are thought to have a higher risk of adverse outcomes than men. The aim of this study was to evaluate sex-related differences in the clinical characteristics and prognosis of patients with STEMI within a system of care. METHOD This study was a subgroup analysis of the Tamil Nadu-STEMI (TN-STEMI) program, a multicentre, prospective, observational study of a quality-improvement program studying patients with STEMI at four hub-and-spoke clusters in the southern state of Tamil Nadu, India. In total, 2,420 patients were enrolled between 2012 and 2014, and the data from all four clusters, pre- and postimplementation of integrated STEMI systems, were combined for this analysis, with a 1-year follow-up. RESULTS The mean ± SD age of presentation of female patients (16%) was significantly later (60.1±10.9 years) compared with males (84%; 53.7±12 years). Diabetes was more prevalent in women (35.2% vs 23.8%; p<0.001), as was hypertension (35.2% vs 22.9%; p<0.001). Symptom to first medical contact in female patients was significantly delayed compared with males (193 mins vs 170 mins; p≤0.009). Women had higher mortality, both in hospital (10.4% vs 4.8%; p≤0.001) and at 1 year (26.7% vs 13%; p≤0.001). This pattern was persistent, even in the younger STEMI (<45 years) population (in-hospital: 9.1% vs 3% [p≤0.05]; at 1 year: 18.2% vs 3% [p≤ 0.05]). In the regression model, females had a 1.8 times increased likelihood (p<0.04) of mortality after adjusting for confounders. CONCLUSIONS Among patients with STEMI, women have an unfavourable risk profile and adverse short- and long-term prognoses when compared to men.
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Affiliation(s)
| | | | | | - Sabari Rajan
- Kovai Medical Centre Hospital, Coimbatore, Tamil Nadu, India
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26
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Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind-Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology. Biomolecules 2021; 11:biom11050708. [PMID: 34068722 PMCID: PMC8151888 DOI: 10.3390/biom11050708] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/28/2022] Open
Abstract
Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women's brains are more sensitive to factors affecting mental health such as depression and stress than men's brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women's mental health can contribute to preventing cardiovascular disease. Mind-body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women's cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind-body intervention in modulating these factors.
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27
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Hussain M, Kumar R, Ammar A, Alishan S, Muhammad AS, Farooq F, Saghir T, Khan N, Hassan Rizvi SN, Ashraf T. Frequency of Thrombolysis in Myocardial Infarction III Flow in Patients With Primary Percutaneous Coronary Intervention: Not All Culprit Vessels Are Completely Occluded in ST Elevation Myocardial Infarction. Cureus 2020; 12:e12036. [PMID: 33457136 PMCID: PMC7797447 DOI: 10.7759/cureus.12036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background ST elevation myocardial infarction (STEMI) is classically characterized by total occlusion of the culprit coronary artery. However during primary percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) 0 flow is not observed in all patients' culprit arteries in angiographic views. This study was conducted to find out the frequency of TIMI flow in acute STEMI patients in view of the above concept. The aim of this study was to evaluate the frequency of pre-procedural TIMI III flow in those patients who underwent primary PCI for acute STEMI in a public sector hospital in Karachi, Pakistan. Methodology This study is an audit of already saved data in the catheterization laboratory of the National Institute of Cardiovascular Diseases (NICVD), Karachi, that was collected prospectively from January 2016 to December 2018. These data were collected after taking consent from those patients who presented to hospital within 12 hours of symptoms and underwent primary PCI. Data were entered and analyzed on Statistical Package for the Social Sciences (SPSS) version 19 (IBM Corp., Armonk, NY, USA). Results A total of 8018 patients were included in this study who presented with STEMI and underwent primary PCI. Out of them 80.9% were males. Hypertension was the leading risk factor in 54.1% (4340) of patients. TIMI III flow was present in 11.4% of patients before primary PCI, while TIMI 0, I and II flow were present in 57.1%, 15.1%, and 16.3% of patients respectively (p<0.001). Fourteen percent of patients with TIMI III flow were of age group 51 to 60 years. Among those who had TIMI III flow, 11.2% were those with door to balloon time of <90 minutes. In 11% of cases, left anterior descending (LAD) artery had TIMI III flow as compared to other vessels (p<0.001). The length of the lesion was significantly smaller in patients who had TIMI III flow compared to those who had TIMI 0-II flow. Conclusions This study revealed that not all patients with acute STEMI had totally occluded culprit coronary artery but some of them had angiographic TIMI I-III flow in the infarct-related artery. Further studies are needed to find the reason for re-establishment of flow in the culprit vessel in STEMI patients before PCI.
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Manfrini O, Cenko E, Bugiardini R. Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the Gap. Curr Atheroscler Rep 2020; 22:65. [PMID: 32880760 DOI: 10.1007/s11883-020-00882-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The review aims to describe the differences between men and women in those factors that can influence a worse prognosis in women after an acute cardiovascular event. RECENT FINDINGS Women adequately treated with current evidence-based medications for acute myocardial infarction and for conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, still have an extra risk of death compared with men. Additional factors that increase the risk of poor prognosis for the index event have been identified. The residual risk can be due to factors affecting the prognosis of the women from outside (they are external to the patient's body) and also to factors that, on the contrary, belong to the female body (female being/female sex). The review will give an update on those residual risk factors, including young age, vulnerability for de novo heart failure, time from symptom onset to treatment, heath care delivered during the weekend, and depression, which generally negatively influence the outcome of women with an acute myocardial infarction.
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Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy.
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Tizón-Marcos H, Vaquerizo B, Marrugat J, Ariza A, Carrillo X, Muñoz JF, Cárdenas M, García-Picart J, Rojas SG, Tomás-Querol C, Massotti M, Lidón RM, Jiménez J, Martí-Almor J, Farré N, Pérez-Fernández S, Curós A, Mauri Ferré J. Complicaciones y mortalidad a 30 días y al año en pacientes con primer IAMCEST tratados en la red Codi IAM en 2010-2016: análisis del efecto del género. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tizón-Marcos H, Vaquerizo B, Marrugat J, Ariza A, Carrillo X, Muñoz JF, Cárdenas M, García-Picart J, Rojas SG, Tomás-Querol C, Massotti M, Lidón RM, Jiménez J, Martí-Almor J, Farré N, Pérez-Fernández S, Curós A, Mauri Ferré J. Differences in 30-day complications and 1-year mortality by sex in patients with a first STEMI managed by the Codi IAM network between 2010 and 2016. ACTA ACUST UNITED AC 2020; 74:674-681. [PMID: 32660910 DOI: 10.1016/j.rec.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES ST-segment elevation myocardial infarction (STEMI) emergency care networks aim to increase reperfusion rates and reduce ischemic times. The influence of sex on prognosis is still being debated. Our objective was to analyze prognosis according to sex after a first STEMI. METHODS This multicenter cohort study enrolled first STEMI patients from 2010 to 2016 to determine the influence of sex after adjustment for revascularization delays, age, and comorbidities. End points were 30-day mortality, the 30-day composite of mortality, ventricular fibrillation, pulmonary edema, or cardiogenic shock, and 1-year all-cause mortality. RESULTS From 2010 to 2016, 14 690 patients were included; 24% were women. The median [interquartile range] time from electrocardiogram to artery opening decreased throughout the study period in both sexes (119 minutes [85-160] vs 109 minutes [80-153] in 2010, 102 minutes [81-133] vs 96 minutes [74-124] in 2016, both P=.001). The rates of primary PCI within 120 minutes increased in the same period (50.4% vs 57.9% and 67.1% vs 72.1%, respectively; both P=.001). After adjustment for confounders, female sex was not associated with 30-day complications (OR, 1.06; 95%CI, 0.91-1.22). However, female 30-day survivors had a lower adjusted 1-year mortality than their male counterparts (HR,0.76; 95%CI, 0.61-0.95). CONCLUSIONS Compared with men, women with a first STEMI had similar 30-day mortality and complication rates but significantly lower 1-year mortality after adjustment for age and severity.
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Affiliation(s)
- Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Jaume Marrugat
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Grupo de Trabajo en Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Carrillo
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan-Francisco Muñoz
- Servicio de Cardiología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Carlos Tomás-Querol
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Mònica Massotti
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - Rosa-Maria Lidón
- Servicio de Cardiología, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josep Jiménez
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Julio Martí-Almor
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Núria Farré
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Sílvia Pérez-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Grupo de Trabajo en Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain
| | - Antoni Curós
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Josepa Mauri Ferré
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
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Evaluation of sex differences in patients with ST-elevated myocardial infarction: an observational cohort study in Amsterdam and surrounding region. Neth Heart J 2020; 28:595-603. [PMID: 32529555 PMCID: PMC7596126 DOI: 10.1007/s12471-020-01435-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Women with ST-elevation myocardial infarction (STEMI) present with different symptoms compared to men. This can result in delays in diagnosis and in the timely treatment of women. The aim of this study is to examine these differences, including the short- and long-term mortality in women and men. Methods This quality registry study included all patients with STEMI who received primary percutaneous coronary intervention in 2015 or 2016 in Amsterdam and the surrounding region. Results Three PCI centres and the Emergency Medical Service in Amsterdam participated. In total, 558 men (71%) and 229 women (29%) were included. Women were on average 7 years older than men (68 vs 61 years, p < 0.001), and suffered more often from hypertension (46% vs 34%, p = 0.002) and monovascular disease (69% vs 57%, p = 0.002). A higher percentage of men were current smokers (41% vs 49%, p = 0.043). Patient delay, system delay and overall ischaemic times were similar in both women and men (medians: 51, 94 and 157 min, respectively). Initiation of treatment was achieved within 90 min after STEMI diagnosis in 85% of patients (87% in women, 85% in men). Thirty-day and 1‑year mortality adjusted hazard ratio for women versus men was 1.60 (95% CI 0.9–3.0) and 1.24 (95% CI 0.8–2.0), respectively. Discussion Recognition of cardiac complaints remains challenging for patients. In the Amsterdam region, time delays and mortality were not significantly different between men and women presenting with STEMI. These results are in contrast to findings in similar registries. This suggests that implementation of current knowledge and national campaigns are effective in increasing awareness of the signs and symptoms suggestive of myocardial infarction.
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Long J, Zeng F, Wang L, Yi C, Chen Q, Zhao H. Gender-specific cardiovascular outcomes in patients undergoing percutaneous coronary intervention in Chinese populations. BMC Cardiovasc Disord 2020; 20:280. [PMID: 32517811 PMCID: PMC7285452 DOI: 10.1186/s12872-020-01563-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 06/02/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Data was limited on the rates of in-hospital and 30-days composite outcomes between male and female patients with coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI). METHODS This was a retrospective study and CHD patients undergoing PCI between January and December of 2018 were screened and recruited. Baseline characteristics, in-hospital and 30-days composite outcomes were compared by gender. The factors influencing gender-outcome associations were evaluated. RESULTS A total of 672 CHD patients undergoing PCI were included into current analysis. Compared to males, females were older (53.8 ± 12.7 years vs 50.6 ± 11.8 years), more likely to be obese (32.9% vs 29.4%) and had higher prevalence of hypertension (46.7% vs 41%). Females were less likely to be smoker (30.3% vs 1.1%), have prior history of CHD (4.4% vs 10.9%), and lower socioeconomic status [SES; full-time employment (64.4% vs 71.9%), education attainment ≥ college (29.6% vs 36.8%) and annual income ≥60,000 RMB (23.7% vs 27.1%)]. Hospitalized stay was longer in females (median 5.2 vs 4.0 days), and females were more likely to experience in-hospital bleeding (3.0% vs 1.2%) and 30-days non-fatal myocardial infarction (5.9% vs 2.9%). In unadjusted model, compared to males, females had a crude odds ratio (OR) of 2.05 (95% confidence interval [CI] 1.68-2.59) for in-hospital composite outcomes and 2.16 (95% CI 1.74-2.63) for 30-days post-PCI composite outcomes. After adjustment for potential covariates, female gender remains independently associated with in-hospital and 30-days post-PCI composite outcomes. OR change was the greatest with adjustment for SES when compared to other covariates. CONCLUSION Compared to male patients, female patients had a higher risk of in-hospital and 30-days composite outcomes post-PCI treatment, which were mainly attributed to the differences in SES.
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Affiliation(s)
- Juan Long
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, China
| | - Fanfang Zeng
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, China
| | - Lili Wang
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, China
| | - Chen Yi
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, China
| | - Qiying Chen
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, China
| | - Honglei Zhao
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, China.
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Cenko E, van der Schaar M, Yoon J, Manfrini O, Vasiljevic Z, Vavlukis M, Kedev S, Miličić D, Badimon L, Bugiardini R. Sex-Related Differences in Heart Failure After ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2020; 74:2379-2389. [PMID: 31699278 DOI: 10.1016/j.jacc.2019.08.1047] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) complicated by symptoms of acute de novo heart failure is associated with excess mortality. Whether development of heart failure and its outcomes differ by sex is unknown. OBJECTIVES This study sought to examine the relationships among sex, acute heart failure, and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS Patients were recruited from a network of hospitals in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776). Main outcome measures were incidence of Killip class ≥II at hospital presentation and risk-adjusted 30-day mortality rates were estimated using inverse probability of weighting and logistic regression models. RESULTS This study included 10,443 patients (3,112 women). After covariate adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation, the incidence of de novo heart failure at hospital presentation was significantly higher for women than for men (25.1% vs. 20.0%, odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.21 to 1.48). Women with de novo heart failure had higher 30-day mortality than did their male counterparts (25.1% vs. 20.6%; OR: 1.29; 95% CI: 1.05 to 1.58). The sex-related difference in mortality rates was still apparent in patients with de novo heart failure undergoing reperfusion therapy after hospital presentation (21.3% vs. 15.7%; OR: 1.45; 95% CI: 1.07 to 1.96). CONCLUSIONS Women are at higher risk to develop de novo heart failure after STEMI and women with de novo heart failure have worse survival than do their male counterparts. Therefore, de novo heart failure is a key feature to explain mortality gap after STEMI among women and men.
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Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy. https://twitter.com/EdinaCenko
| | | | - Jinsung Yoon
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California
| | - Olivia Manfrini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Marija Vavlukis
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lina Badimon
- Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.
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Sex Differences in the Outcomes of Elderly Patients with Acute Coronary Syndrome. Cardiol Res Pract 2020; 2020:5091490. [PMID: 32454999 PMCID: PMC7240792 DOI: 10.1155/2020/5091490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background The impact of sex on the outcome of patients with acute coronary syndrome (ACS) has been suggested, but little is known about its impact on elderly patients with ACS. Methods This study analyzed the impact of sex on in-hospital and 1-year outcomes of elderly (≥75 years of age) patients with ACS hospitalized in our department between January 2013 and December 2017. Results A total of 711 patients were included: 273 (38.4%) women and 438 (61.6%) men. Their age ranged from 75 to 94 years, similar between women and men. Women had more comorbidities (hypertension (79.5% vs. 72.8%, p=0.050), diabetes mellitus (35.2% vs. 26.5%, p=0.014), and hyperuricemia (39.9% vs. 32.4%, p=0.042)) and had a higher prevalence of non-ST-segment elevation ACS (NSTE-ACS) (79.5% vs. 71.2%, p=0.014) than men. The prevalence of current smoking (56.5% vs. 5.4%, p < 0.001), creatinine levels (124.4 ± 98.6 vs. 89.9 ± 54.1, p < 0.001), and revascularization rate (39.7% vs. 30.0%, p=0.022) were higher, and troponin TnT and NT-proBNP tended to be higher in men than in women. The in-hospital mortality rate was similar (3.5% vs. 4.4%, p=0.693), but the 1-year mortality rate was lower in women than in men (14.7% vs. 21.7%, p=0.020). The multivariable analysis showed that female sex was a protective factor for 1-year mortality in all patients (OR = 0.565, 95% CI 0.351–0.908, p=0.018) and in patients with STEMI (OR = 0.416, 95% CI 0.184–0.940, p=0.035) after adjustment. Conclusions Among the elderly patients with ACS, the 1-year mortality rate was lower in women than in men, which could be associated with comorbidities and ACS type.
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Moore K, Ganesan A, Labrosciano C, Heddle W, McGavigan A, Hossain S, Horton D, Hariharaputhiran S, Ranasinghe I. Sex Differences in Acute Complications of Cardiac Implantable Electronic Devices: Implications for Patient Safety. J Am Heart Assoc 2020; 8:e010869. [PMID: 30648465 PMCID: PMC6497358 DOI: 10.1161/jaha.118.010869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background To date, limited population‐level studies have examined the impact
of sex on the acute complications of cardiac implantable electronic devices
(CIED), including permanent
pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization
therapy devices. Methods and Results We studied all patients aged >18 years from 2010 to 2015 who were
a resident of Australia or New Zealand, undergoing a new permanent pacemaker,
implantable cardioverter defibrillator, or cardiac resynchronization
therapy implant. Standardized variables were collected including patient
demographic characteristics, primary and secondary diagnoses, procedures performed
and discharge status. Diagnoses and procedures were coded as per the
International Classification of Diseases, Tenth Revision
(ICD‐10) and the Australian Classification of Health
Interventions. The primary end point was the incidence of major CIED‐related complications in‐hospital or
within 90 days of discharge, with the effect of sex evaluated using multiple
logistic regression. A total of 81 304 new CIED (61 658 permanent pacemakers, 12 097 implantable
cardioverter defibrillators, 7574 cardiac resynchronization therapy) implants were
included (38% women). Overall, 8.5% of women and 8.0% of men experienced a
CIED complication
(P=0.008). Differences between women and men remained
significant after adjustment for age, procedural acuity, and comorbidities (odds
ratio 1.10, 95% CI: 1.04–1.16, P<0.001). Differences in
CIED complication rates
were primarily driven by excess rate of in‐hospital pleural drainage (1.2% women
versus 0.6% men, P<0.001; adjusted odds ratio 1.86, 95% CI:
1.59–2.17, P<0.001) and pericardial drainage (0.3% women
versus 0.1% men, P<0.001; adjusted odds ratio 2.17, 95% CI:
1.48–3.18, P<0.001). Conclusions Women are at higher risk of acute CIED complications. Improvements in implant technique and
technologies are required to minimize the risk of implant‐related complications in
women.
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Affiliation(s)
- Katherine Moore
- 1 College of Medicine and Public Health Flinders University Bedford Park South Australia
| | - Anand Ganesan
- 1 College of Medicine and Public Health Flinders University Bedford Park South Australia
| | | | - William Heddle
- 1 College of Medicine and Public Health Flinders University Bedford Park South Australia.,2 Department of Cardiology Flinders Medical Centre Bedford Park South Australia
| | - Andrew McGavigan
- 1 College of Medicine and Public Health Flinders University Bedford Park South Australia.,2 Department of Cardiology Flinders Medical Centre Bedford Park South Australia
| | - Sadia Hossain
- 3 Health Performance & Policy Research Unit Basil Hetzel Institute for Translational Research Woodville South South Australia.,4 Discipline of Medicine University of Adelaide South Australia
| | - Dennis Horton
- 3 Health Performance & Policy Research Unit Basil Hetzel Institute for Translational Research Woodville South South Australia.,4 Discipline of Medicine University of Adelaide South Australia.,5 Health Analytics Program Data to Decisions Cooperative Research Centre Adelaide South Australia
| | - Saranya Hariharaputhiran
- 3 Health Performance & Policy Research Unit Basil Hetzel Institute for Translational Research Woodville South South Australia.,4 Discipline of Medicine University of Adelaide South Australia
| | - Isuru Ranasinghe
- 3 Health Performance & Policy Research Unit Basil Hetzel Institute for Translational Research Woodville South South Australia.,4 Discipline of Medicine University of Adelaide South Australia.,6 Department of Cardiology Central Adelaide Local Health Network Adelaide South Australia
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Dar M, Sharma A, Iqbal M, Tramboo N. Gender-based differences in coronary artery disease: A prospective observational study from a North Indian state. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_13_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vautrin E, Jean ABP, Fourny M, Marlière S, Vanzetto G, Bouvaist H, Debaty G, Belle L, Danchin N, Labarère J. Sex differences in coronary artery lesions and in‐hospital outcomes for patients with ST‐segment elevation myocardial infarction under the age of 45. Catheter Cardiovasc Interv 2019; 96:1222-1230. [DOI: 10.1002/ccd.28627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Estelle Vautrin
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | | | - Magali Fourny
- Quality of Care Unit Grenoble Alpes University Hospital Grenoble France
| | - Stéphanie Marlière
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Gérald Vanzetto
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Hélène Bouvaist
- Department of Cardiology Grenoble Alpes University Hospital Grenoble France
| | - Guillaume Debaty
- TIMC, UMR 5525, CNRS Université Grenoble Alpes Grenoble France
- Department of Emergency Medicine Grenoble Alpes University Hospital Grenoble France
| | - Loïc Belle
- Department of Cardiology Annecy‐Genevois Hospital, Réseau nord alpin des urgences (RENAU) Annecy France
| | - Nicolas Danchin
- Department of Cardiology Hôpital Européen Georges Pompidou, Assistance Publique‐Hôpitaux de Paris Paris France
| | - José Labarère
- Quality of Care Unit Grenoble Alpes University Hospital Grenoble France
- TIMC, UMR 5525, CNRS Université Grenoble Alpes Grenoble France
- CIC 1406, INSERM Grenoble Alpes University Hospital Grenoble France
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Bęćkowski M, Kowalik I, Jaworski K, Dąbrowski R, Gierlotka M, Gąsior M, Poloński L, Zdrojewski T, Karwowski J, Drygas W, Szwed H. Differences in Symptomatology and Clinical Course of Acute Coronary Syndromes in Women ≤45 Years of Age Compared to Older Women. Curr Probl Cardiol 2019; 46:100508. [PMID: 31898981 DOI: 10.1016/j.cpcardiol.2019.100508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/29/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
Acute coronary syndromes (ACS) in young people are rare. The data regarding differences in symptoms in relation to age are scarce, which may have an influence on outcomes. The aim of this study was to evaluate the differences in the clinical course of ACS between younger women (≤45 years old) and older women (63-64 years old). We compared 7481 women with ACS from the Polish Registry of ACS between 2007 and 2014 (1834 women aged ≤45 years and 5647 women aged 63-64 years). The predominant symptom of ACS in both groups was chest pain, with a higher incidence occurring in younger women (90.4% vs 88.5%, P = 0.025). Prehospital cardiac arrest occurred more often in younger women (2.1% vs 0.8%, P < 0.001), and onset-to-balloon time was shorter (8.9 vs 15.2 hours, P < 0.0001) in this group. Younger women presented with a lower Killip class at admission (class I at admission: 92.7% vs 86.2%, P < 0.001). The dominant type of ACS in the younger cohort was ST-segment elevation myocardial infarction (STEMI) (42% vs 26.1%), localized mainly in the anterior wall (47.7% vs 36.1%, P < 0.001), with a higher percentage of total occlusion of infarct-related artery (TIMI 0, 45.2% vs 36.1%) and left anterior descending artery engagement for all (33.5% vs 26.5%, P < 0.001). Drug-eluting stents were often used in the younger patients (43.3% vs 38.2%, P = 0.003) without significant differences in percutaneous coronary intervention numbers. Pharmacotherapy was used less in younger women. The 30-day and 2-year mortality in young women was lower than in the older cohort. The clinical course of ACS in younger women differed in comparison to older women. Younger women had a higher occurrence of typical chest pain, STEMI, and left anterior descending artery engagement. Except STEMI patients young women received faster revascularization, however with no significant differences in invasive treatment. Pharmacotherapy was inadequate in younger women and that resulted in a lower usage of the beta-blockers, angiotensin-converting enzyme inhibitors, and statins in that group. Short- and long-term mortality was low, regardless of the type of ACS.
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Mohamed MO, Volgman AS, Contractor T, Sharma PS, Kwok CS, Rashid M, Martin GP, Barker D, Patwala A, Mamas MA. Trends of Sex Differences in Outcomes of Cardiac Electronic Device Implantations in the United States. Can J Cardiol 2019; 36:69-78. [PMID: 31740167 DOI: 10.1016/j.cjca.2019.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The disparity in outcomes of cardiac electronic device implantations between sexes has been previously demonstrated in device-specific cohorts (eg, implantable cardioverter-defibrillators [ICDs]). However, it is unclear whether sex differences are present with all types of cardiac implantable electronic devices (CIEDs) and, if so, what the trends of such differences have been in recent years. METHODS With the use of the National Inpatient Sample, all hospitalizations from 2004 to 2014 for de novo implantation of permanent pacemakers, cardiac resynchronization therapy with or without a defibrillator, and ICDs were analyzed to examine the association between sex and in-hospital acute complications of CIED implantation. RESULTS Out of 2,815,613 hospitalizations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased adjusted odds (95% confidence interval) of adverse procedural complications (major adverse cardiovascular complications: 1.17 [1.16-1.19]; bleeding: 1.13 [1.12-1.15],-thoracic: 1.42 [1.40-1.44]; cardiac: 1.44 [1.38-1.50]), whereas the adjusted odds of in-hospital all-cause mortality compared with men was 0.96 (0.94-1.00). The odds of adverse complications in the overall CIED cohort were persistently raised in women throughout the study period, whereas similar odds of all-cause mortality across the sexes were observed throughout the study period. CONCLUSION In a national cohort of CIED implantations we demonstrate that women are at an overall higher risk of procedure-related adverse events compared with men, but not at increased risk of all-cause mortality. Further studies are required to identify procedural techniques that would improve outcomes among women undergoing such procedures.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | | | - Tahmeed Contractor
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Parikshit S Sharma
- Section of Cardiology, Rush Heart Center for Women, Rush University, Chicago, Illinois, USA
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Diane Barker
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Ashish Patwala
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Abstract
BACKGROUND Despite advancements in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the elderly population. Previous research has highlighted long-standing sex disparities in the care of these patients. However, differences in the patterns of discharge are not well described. One key parameter is the destination of discharge, and in particular - discharge to skilled nursing facilities (SNFs), a factor associated with worse prognosis and greater costs to the healthcare system. Our aim, therefore, was to observe destination differences after AMI on the basis of sex and other baseline characteristics. MATERIALS AND METHODS From a cohort of 143 180 claims, we carried out an observational analysis of 6123 Medicare beneficiaries discharged following AMI during the first quarter of 2016. RESULTS For patients who were referred from SNF, the rates of in-hospital death are higher, even after adjustment for baseline characteristics (odds ratio: 1.78, 95% confidence interval: 1.17-2.70). Of those discharged to SNF or home, 36.33% of the female patients were discharged to an SNF versus 25.12% (P<0.01) of the male patients. After adjusting for baseline characteristics, discharge to SNF remained significantly higher among female patients (odds ratio: 1.57, 95% confidence interval: 1.27-1.94). CONCLUSION Discharge to SNF following AMI is more frequent for female patients, even after adjustment for risk factors. Our findings highlight the need to better characterize this unique patient population and understand the cycle of care that they receive following AMI.
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Herscovici R, Mirocha J, Salomon J, Merz NB, Cercek B, Goldfarb M. Sex differences in crude mortality rates and predictive value of intensive care unit-based scores when applied to the cardiac intensive care unit. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:966-974. [PMID: 31452378 DOI: 10.1177/2048872619872129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data exists regarding sex differences in outcome and predictive accuracy of intensive care unit-based scoring systems when applied to cardiac intensive care unit patients. METHODS We reviewed medical records of patients admitted to cardiac intensive care unit from 1 January 2011-31 December 2016. Sex differences in mortality rates and the performance of intensive care unit-based scoring systems in predicting in-hospital mortality were analyzed. Calibration was assessed by the Hosmer-Lemeshow test and locally weighted scatterplot smoothing curves. Discrimination was assessed using the c statistic and receiver-operating characteristic curve. RESULTS Among 6963 patients, 2713 (39%) were women. Overall in-hospital and cardiac intensive care unit mortality rates were similar in women and men (9.1% vs 9.4%, p=0.67 and 5.9% vs 6%, p=0.88, respectively) and in age and major diagnosis subgroups. Of the scoring systems, Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment had poor calibration (Hosmer-Lemeshow p value <0.001), while Simplified Acute Physiology Score II performed better (Hosmer-Lemeshow p value 0.09), in both women and men. All scores had good discrimination (C statistics >0.8). In the subgroups of acute myocardial infarction and heart failure patients, all scores had good calibration (Hosmer-Lemeshow p>0.001) and discrimination (C statistic >0.8) while in diagnosis subgroups with highest mortality, the calibration varied among scores and by sex, and discrimination was poor. CONCLUSIONS No sex differences in mortality were seen in cardiac intensive care unit patients. The mortality predictive value of intensive care unit-based scores is limited in both sexes and variable among different subgroups of diagnoses.
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Affiliation(s)
| | - James Mirocha
- Division of Biostatistics, Cedars-Sinai Medical Center, USA
| | | | - Noel B Merz
- Barbra Streisand Women's Heart Center, Smidt Cedars-Sinai Heart Institute, USA
| | - Bojan Cercek
- Smidt Heart Institute, Cedars-Sinai Medical Center, USA
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Ravn-Fischer A, Perers E, Karlsson T, Caidahl K, Hartford M. Seventeen-Year Mortality following the Acute Coronary Syndrome: Gender-Specific Baseline Variables and Impact on Outcome. Cardiology 2019; 143:22-31. [PMID: 31352455 DOI: 10.1159/000501166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated. OBJECTIVES To assess long-term mortality and explore its association with the baseline variables in women and men. METHODS We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months. RESULTS At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender. CONCLUSION For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.
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Affiliation(s)
- Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Perers
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Marianne Hartford
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
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Kiron V, George PV. Correlation of cumulative ST elevation with left ventricular ejection fraction and 30-day outcome in patients with ST elevation myocardial infarction. J Postgrad Med 2019; 65:146-151. [PMID: 31169133 PMCID: PMC6659429 DOI: 10.4103/jpgm.jpgm_364_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/11/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background The electrocardiogram (ECG) is the first and often the only investigation available prior to definitive therapy in patients with ST elevation myocardial infarction (STEMI). A good prognostic marker is the left ventricular ejection fraction (LVEF) on ECG. Our aim was to assess the correlation between ST elevation (STE) in ECG and the LVEF and thereby aid the prognosis of patients with STEMI. Methods This was a prospective cohort study of 230 patients with STEMI. A baseline 12-lead ECG was taken to calculate the sum of STE at the J point in all the leads showing elevation. The STE was measured 90 min after revascularization to calculate the ST resolution percentage (STR%). All patients underwent echocardiography, and the LVEF was measured using biplane Simpson's method. Results A total of 136 patients with anterior myocardial infarction (MI), 35 with inferior MI, and 59 with inferoposterior MI were included in the study. Mean STE was 13 mm and was significantly higher among patients with anterior MI. There was a good inverse correlation between the STE and the LVEF with a correlation coefficient of -0.64. STR% had a correlation coefficient of 0.59 to the LVEF. A formula was generated to calculate the LVEF based on the STE as follows: LVEF = (37.34 - STE)/0.567. An STE ≥15 mm predicted an LVEF <35% with a sensitivity and specificity of 70%. Conclusion The STE and STR% are useful surrogate markers in prognosticating patients irrespective of the type of STEMI.
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Affiliation(s)
- V Kiron
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PV George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
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Menopause improves the predictive value of common cardiovascular risk scores in women with premature coronary artery disease. Menopause 2019; 25:408-414. [PMID: 29206775 DOI: 10.1097/gme.0000000000001029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Menopause, particularly its early stage (≤3 years from onset), may be an important risk factor for premature coronary artery disease. The objective of the study was to assess whether the addition of the presence of menopause in women with premature coronary artery disease could improve the predictive value of the Atherosclerotic Cardiovascular Disease risk estimator and the Systematic COronary Risk Evaluation model. METHODS The case-control study included 307 women with coronary artery disease aged 55 or less, and 347 age-matched controls without coronary artery disease. Diagnostic accuracy parameters were evaluated for traditional risk models versus those enriched with menopausal status. Early and late postmenopausal periods were defined as ≤3 and >3 years from the onset of menopause, respectively. RESULTS Only the addition of the presence of the early postmenopausal stage to the 10-year Atherosclerotic Cardiovascular Disease risk classes resulted in significantly increased c-statistics from 0.66 (95% confidence interval [CI] 0.62-0.7) to 0.705 (95%CI 0.66-0.75) (P = 0.0003) and an increase of accuracy from 61.3% to 63.8% (P = 0.0025).Adding the presence of early postmenopause to the Systematic COronary Risk Evaluation risk classes also resulted in significantly increased c-statistics from 0.59 (95% CI 0.55-0.63) to 0.641 (95%CI 0.6-0.68) (P = 0.0024) and an increase of accuracy from 64.1% versus 57.5% (P = 0.001). CONCLUSION Adding the early menopausal period may significantly improve the predictive value of the 10-year Atherosclerotic Cardiovascular Disease risk score and the Systematic COronary Risk Evaluation model in women with premature coronary artery disease.
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Outcomes by Gender and Ethnicity After Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:1941-1948. [PMID: 31005238 DOI: 10.1016/j.amjcard.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/03/2019] [Accepted: 03/14/2019] [Indexed: 01/05/2023]
Abstract
Limited data on gender differences by ethnicity after percutaneous coronary intervention (PCI) exist. In this prospective cohort study, we examined gender differences in 1-year outcomes among patients from 4 ethnic groups who underwent PCI from 2010 to 2016 at a tertiary center. The primary outcome was 1-year major adverse cardiovascular events (MACE) defined as composite of all-cause death, nonfatal myocardial infarction (MI), or target lesion revascularization. Secondary outcomes included composite of death or MI and individual components of MACE. Baseline characteristics and outcomes were compared between gender in each ethnic group. The study included 16,361 patients: 7,881 whites (26.1% women), 1,943 blacks (47.3% women), 2,621 Asians (22.6% women), and 3,916 Hispanics (39.3% women). Women were older with more co-morbidities than men. Unadjusted, women had higher incidence of 1-year MACE than men among whites and Asians but not blacks or Hispanics, which was driven by a greater incidence of death in white women and greater incidence of MI in Asian women compared with male counterparts. After adjustment, findings showed similar risk of 1-year MACE in women versus men in whites, Asians, and Hispanics (Whites: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78 to 1.16; Asians: HR 1.14, 95% CI 0.77 to 1.67; Hispanics: HR 0.97, 95% CI 0.74 to 1.27). Black women had lower risk of 1-year MACE compared with black men (HR 0.67, 95% CI 0.46 to 0.97), driven by lower risk of death or MI. In conclusion, this study suggests that risk factors account for adverse events in women after PCI.
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Rao U, Buchanan GL, Hoye A. Outcomes After Percutaneous Coronary Intervention in Women: Are There Differences When Compared with Men? ACTA ACUST UNITED AC 2019; 14:70-75. [PMID: 31178932 PMCID: PMC6545995 DOI: 10.15420/icr.2019.09] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Despite advances in the diagnosis and treatment of coronary artery disease, there remains evidence of a disparity in the outcomes for women when compared with men. This article provides a review of the evidence for this discrepancy and discusses some of the potential contributing factors.
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Affiliation(s)
- Usha Rao
- Department of Cardiology, Castle Hill Hospital Kingston upon Hull, UK
| | - G Louise Buchanan
- Department of Cardiology, Cumberland Infirmary, Newtown Road Carlisle, UK
| | - Angela Hoye
- Department of Cardiology, Castle Hill Hospital Kingston upon Hull, UK
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Ten Haaf ME, Bax M, Ten Berg JM, Brouwer J, Van't Hof AW, van der Schaaf RJ, Stella PR, Tjon Joe Gin RM, Tonino PA, de Vries AG, Zijlstra F, Boersma E, Appelman Y. Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands. Neth Heart J 2019; 27:263-271. [PMID: 30989470 PMCID: PMC6470244 DOI: 10.1007/s12471-019-1271-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands. METHODS This registry is a merge of available data on ACS patients in the electronic data capture systems of 11 centres with 24/7 interventional cardiology services. We included patients >18 years undergoing a cardiac catheterisation between 2010-2012. We evaluated sex differences in clinical and procedural characteristics and 1‑year mortality. RESULTS A total of 29,265 ACS patients (8,720 women and 20,545 men) were registered. Women were on average 4.5 years older (68.5 vs 63.0 years, p < 0.001) and had a higher prevalence of hypertension (62.7 vs 49.8%, p < 0.001) and insulin-dependent diabetes mellitus (9.6 vs 6.8%, p < 0.001) than men. Women less often presented with ST-elevation myocardial infarction (43.7% vs 47.6%, p < 0.001) and appeared to have less extensive coronary artery disease than men. Women less often underwent coronary angiography by radial access (52.5 vs 55.9%, p < 0.001). One-year mortality was higher in women than in men (7.3% and 5.6%, p < 0.001). More specific, the relationship between sex and mortality was age-dependent and showed higher mortality in women ≤71 years, but lower mortality in older women compared with men (p-interaction <0.001). CONCLUSION We found differences in clinical and procedural characteristics and outcome between women and men admitted for ACS, which are in line with other Western countries. The limitations of our registry, based on existing local databases, can be overcome by the use of the prospective Netherlands Heart Registry that is currently in development.
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Affiliation(s)
- M E Ten Haaf
- Department of Cardiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands.
- The Netherlands Heart Institute, Utrecht, The Netherlands.
| | - M Bax
- Department of Cardiology, HAGA Hospital, The Hague, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Brouwer
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A W Van't Hof
- Department of Cardiology, MUMC, Maastricht, The Netherlands
- Department of Cardiology, Zuyderland MC, Heerlen, The Netherlands
| | - R J van der Schaaf
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis location East, Amsterdam, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R M Tjon Joe Gin
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - P A Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - A G de Vries
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - F Zijlstra
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Janet Wei
- Barbara Streisand Women’s Heart Center, Cedars-Sinai Smdit Heart Institute, Los Angeles, California, USA
| | - Timothy D Henry
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbara Streisand Women’s Heart Center, Cedars-Sinai Smdit Heart Institute, Los Angeles, California, USA
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Qi Y, Wang W, Zhang K, An S, Wang S, Zheng J, Tang YD. Development and validation of Women Acute Myocardial Infarction in-Hospital Mortality Score (WAMI Score). Int J Cardiol 2018; 259:31-39. [PMID: 29579607 DOI: 10.1016/j.ijcard.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/07/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND A variety of risk models have been developed to predict acute myocardial infarction (AMI) in-hospital mortality risk. As a distinct, higher-risk population, women with AMI have different risk profiles from their men counterparts. Published researches have indicated that the interaction between variables in these models for in-hospital mortality and gender are significant. Due to the interaction and gender differences, the predicting value of these risk models for women could be controversial. METHODS Databases from the China Patient-centered Evaluative Assessment of Cardiac Events (China PEACE) Retrospective AMI Study were utilized for model derivation (n=16,100, women were 4896) and databases from the China PEACE Prospective AMI Study for model validation (n=6207, women were 2090). A multivariable backward stepwise logistic regression was used to examine correlates of in-hospital mortality, and the variables were subsequently weighted and integrated into a scoring system. RESULTS We constructed a novel risk-predicting tool to estimate the baseline risk of in-hospital mortality among women with AMI. The risk score includes 8 variables [age, systolic blood pressure, heart rate, initial glomerular filtration rate (GFR), serum glucose, Killip class, cardiac arrest, ventricular tachycardia/ventricular fibrillation (VT/VF)]. The prognostic discriminatory capacity of the Women Acute Myocardial Infarction in-Hospital Mortality (WAMI) risk score was excellent (c statistic 0.84, 95% confidence interval [CI]: 0.83 to 0.86, p<0.001). External validation of the model showed better prognostic capacity (c statistic 0.87, 95% CI: 0.84 to 0.90, p<0.001) than the GRACE risk score (0.77, 95% CI 0.72-0.82, p<0.001) and TIMI risk score (0.72, 95% CI 0.68-0.77, p<0.001). CONCLUSIONS The WAMI Score is a simple robust tool for predicting the in-hospital mortality risk of women with AMI. TRIAL REGISTRATION "China PEACE-Retrospective AMI Study", NCT01624883, retrospectively registered: April 2012. Date of enrolment of the first participant to the trial: June 17, 2012. "China PEACE-Prospective AMI Study", NCT01624909, prospectively registered: December 2012. Date of enrolment of the first participant to the trial: June 17, 2012.
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Affiliation(s)
- Yu Qi
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wenyao Wang
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kuo Zhang
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shimin An
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Siyuan Wang
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jilin Zheng
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yi-Da Tang
- Department of Internal Medicine, Coronary Heart Disease Center, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Guo Y, Yin F, Fan C, Wang Z. Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11644. [PMID: 30045311 PMCID: PMC6078653 DOI: 10.1097/md.0000000000011644] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous researches have reported the controversial results regarding the gender difference in clinical outcomes of patients with coronary artery disease after percutaneous coronary intervention. Hence, this systematic review and meta-analysis was designed to investigate whether gender difference existed in patients with coronary artery disease after percutaneous coronary intervention. METHODS PubMed, Embase, and the Cochrane Library database were searched up to February 10, 2018. Studies comparing the gender-specific effect on clinical outcomes of patients with coronary artery disease after percutaneous coronary intervention were identified, to analyze mortality, major adverse cardiovascular events (MACE) and revascularization. Statistical software RevMan was utilized in this meta-analysis. RESULTS A total of 49 studies, involving 1,032,828 patients (774,115 males and 258,713 females) reporting gender-specific outcomes, were included in this study. The in-hospital mortality, 30-day mortality, 1-year mortality, and at least 2-years mortality in male patients with coronary artery disease after percutaneous coronary intervention were significantly lower than those of females (odds ratio [OR] 0.58 95% confidence interval [CI] 0.52-0.63, P < .001; OR 0.64, 95% CI 0.61-0.66, P = .04; OR 0.67, 95% CI 0.60-0.75, P < .001 and OR 0.71, 95% CI 0.63-0.79, P = .005, respectively). The MACE was significantly decreased in male subjects after initial percutaneous coronary intervention compared with females in <1-year or at least 1-year (OR 0.67, 95% CI 0.56-0.80, P < .001 and OR 0.84, 95% CI 0.76-0.93, P < .001). The male patients after percutaneous coronary intervention harbored higher rate of revascularization compared with females for at least 1-year (OR 1.17, 95% CI 1.00-1.36, P < .001), while the rate of revascularization in male patients for < 1-year was lower than that of females (OR 0.93, 95% CI 0.69-1.26, P < .001). CONCLUSIONS The systematic review and meta-analysis suggests that the prognosis of male patients with coronary artery disease after percutaneous coronary intervention is better than that of females, except for long-term revascularization.
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Affiliation(s)
- Yaya Guo
- The First Medical Clinical College of Lanzhou University
| | - Fahui Yin
- The First Medical Clinical College of Lanzhou University
| | - Chunlei Fan
- The First Medical Clinical College of Lanzhou University
| | - Zhilu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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