Age-Stratified Sex Disparities in Care and Outcomes in Patients With ST-Elevation Myocardial Infarction

Liu, Jing; Elbadawi, Ayman; Elgendy, Islam Y.; Megaly, Michael; Ogunbayo, Gbolahan; Krittanawong, Chayakrit; Tamis‐Holland, Jacqueline E.; Ballantyne, Christie M.; Khalid, Mirza Umair; Virani, Salim S.; Gulati, Martha; Albert, Michelle A.; Bozkurt, Biykem; Jneid, Hani

doi:10.1016/j.amjmed.2020.03.059

Cited by 41 publications

(26 citation statements)

References 27 publications

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“…Lower reperfusion rates in women compared to men have been largely reported since the thrombolytic era 12 and continue to persist after the development primary PCI networks. 4,[13][14][15][16] Similarly, lower rates of early invasive therapy in NSTE-ACS patients have been described in women compared with men. 17,18 Several reasons may be hypothesized to explain these findings, including less typical symptoms in women, possibly leading to delayed acute coronary syndrome diagnosis and, as a consequence, delayed specific therapies including reperfusion.…”

Section: Discussionmentioning

confidence: 98%

Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Rosa

Morici

Luca

et al. 2021

The American Journal of Medicine

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BACKGROUND: Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). METHODS: Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. RESULTS: A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. CONCLUSIONS: Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.

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Section: Discussionmentioning

confidence: 98%

Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Rosa

Morici

Luca

et al. 2021

The American Journal of Medicine

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“…Shehab et al [24] analyzed 15,532 hospitalized patients with STEMI in the Arabian Gulf region and found that younger women (aged ≤ 65 years) had a higher crude adjusted in-hospital and 1 year mortality rates than younger men and were less likely to receive guideline-recommended pharmacotherapy [24]. Another study analyzing 1,260,200 hospitalizations for STEMI in the United States found that younger women with STEMI (19-49 years of age) experienced higher in-hospital mortality that persisted after a multivariable adjustment [25]. Previous studies mainly reported sex differences in short-term mortality, but after adjusting for age, risk factors, and comorbidities these differences disappeared [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Lorca

Pascual

Aparicio

et al. 2021

JCM

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Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

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“…Recurrent MI, heart failure, and stroke occur more frequently in women during this same time period [1]. In a study by Liu et al, in-hospital mortality rates were higher for women increasing across age groups ranging from 3.9% in the youngest group (19-49 years old) to 20.5% in the oldest (> 80 years old) [33], but after multivariant adjustment, the increased mortality in women compared with men was only significant in those aged 19-49 years (OR = 1.259, 95% CI 1.083-1.464, p = 0.003).…”

Section: Sex Differences In Outcomesmentioning

confidence: 91%

“…Despite increasing awareness of sex-specific differences in care of these patients, women continue to receive less revascularization and reperfusion therapies compared to men. A large retrospective study from 2010 to 2016 looked at 1,260,200 hospitalizations in the US for STEMI (32% women) and subsequent therapies received stratified by sex [33]. After multivariable adjustment, women were less likely to receive fibrinolytic therapy (OR = 0.924, 95% CI 0.860-0.994, p = 0.033), PCI (OR = 0.739, 95% CI 0.723-0.756, p < 0.001), or CABG (OR = 0.540, 95% CI 0.540-0.590, p < 0.001).…”

Section: Sex Differences In Treatmentmentioning

confidence: 99%

Diagnostic and Management Dilemmas in Women Presenting with Acute Coronary Syndromes

et al. 2020

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Purpose of Review To summarize gender-and sex-specific differences in the presentation, diagnosis, management, and pathophysiology of women presenting with acute coronary syndrome (ACS). Recent Findings Sex differences exist in many aspects of ACS that impact the identification, treatment, and outcomes in women. There are delays in the initiation of care, under recognized diagnostic differences based on sex, and inconsistencies in the management of ACS in women compared with men, that ultimately impact outcomes. Additionally, women with ACS are more likely than men to present with non-obstructive coronary artery disease (CAD), which appears to be due to diverse underlying pathophysiology. Summary Women with ACS face diagnostic and treatment dilemmas from time of symptom onset to hospital discharge. Underrecognition, under-diagnosis, and under-treatment ultimately result in poorer outcomes in women. Underlying pathophysiologic differences in women require additional testing to elucidate underlying etiologies. Keywords Cardiovascular disease . Myocardial infarction . Acute coronary syndrome . Women . Sex differences . Myocardial infarction with non-obstructive coronaries (MINOCA) This article is part of the Topical Collection on Management of Acute Coronary Syndromes

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Age-Stratified Sex Disparities in Care and Outcomes in Patients With ST-Elevation Myocardial Infarction

Cited by 41 publications

References 27 publications

Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Diagnostic and Management Dilemmas in Women Presenting with Acute Coronary Syndromes

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