Comparison of Outcomes of Coronary Revascularization for Acute Myocardial Infarction in Men Versus Women

Mahowald, Madeline; Alqahtani, Fahad; Alkhouli, Mohamad

doi:10.1016/j.amjcard.2020.07.014

Cited by 31 publications

(28 citation statements)

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“…Generally, women are reported to be older, have more comorbidities and have lower rates of receiving PCI and evidence-based treatment than men (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The unadjusted in-hospital and long-term mortality in women tend to be higher than in men, and this difference is more pronounced in STEMI subpopulation (3)(4)(5)(6)(7). However, this sex disparity in mortality became attenuated or even non-significant after age or multivariate adjustment (8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

“…The sex differences in clinical presentation, treatment and outcomes of patients with acute myocardial infarction (AMI) have been investigated for decades (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Generally, women with AMI have a greater burden of comorbidity and atypical symptoms than men.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies report a higher unadjusted mortality for women after AMI, which is mainly explained by differences in age, comorbidities and use of guideline-based treatment (3)(4)(5)(6)(7). Meanwhile, others claim that the adjusted rates of mortality and cardiovascular (CV) events for men and women are similar, suggesting that both sexes can benefit from the current developed therapies (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Gao

Wahab

Huang

et al. 2021

Front. Cardiovasc. Med.

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Background: Sex differences in clinical profiles and prognosis after acute myocardial infarction have been addressed for decades. However, the sex-based disparities among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remain largely unreported. Here, we investigated sex-specific characteristics and long-term outcomes in MINOCA population.Methods: A total of 1,179 MINOCA patients were enrolled, including 867 men and 312 women. The mean follow-up was 41.7 months. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal reinfarction, revascularization, non-fatal stroke, and hospitalization for unstable angina or heart failure. Baseline data and outcomes were compared. Kaplan-Meier curves and Cox regression analyses were used to identify association between sex and prognosis.Results: Female patients with MINOCA had more risk profiles with regard to older age and higher prevalence of hypertension and diabetes compared with men. The evidence-based medical treatment was similar in men and women. The incidence of MACE (men vs. women: 13.8 vs. 15.3%, p = 0.504) did not differ significantly between the sexes. The Kaplan-Meier analysis also indicated that women had a similar incidence of MACE compared to men (log rank p = 0.385). After multivariate adjustment, female sex was not associated with the risk of MACE in overall (adjusted hazard ratio 1.02, 95% confidence interval: 0.72–1.44, p = 0.916) and in subgroups of MINOCA patients.Conclusion: The long-term outcomes were similar for men and women presenting with MINOCA despite older age and more comorbidities in women. Future research should aim to improve in-hospital and post-discharge care for both sexes with MINOCA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Gao

Wahab

Huang

et al. 2021

Front. Cardiovasc. Med.

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“…16,17 In 3 large contemporary reports (ranging from 1.8 to 3.8 million patients each), women comprised a lower percentage of overall CABG use and a higher operative mortality after CABG. 5,23,24 Using the National Inpatient Sample database, Mahowald and colleagues 24 demonstrated a consistently higher in-hospital mortality before and after propensity matching in women undergoing CABG after myocardial infarction, compared with men between 2003 and 2016 in 3.6 million patients (33% women). Also using the National Inpatient Sample, Mohamed and colleagues 24 found declining mortality in all patients (2.5 million, 28% women) over time (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) after CABG; however, mortality was persistently higher in women, even after adjustment for risk factors, and women had a 43% increased odds of mortality compared with men.…”

Section: Operative Mortality In Women Compared With Menmentioning

confidence: 99%

Coronary surgery in women: How can we improve outcomes

2021

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This Invited Expert Opinion is based on the presentation by Dr Jennifer Lawton at the 2021 American Association for Thoracic Surgery Meeting, International Coronary Congress Session. In this opinion, we consider the factors that contribute to the differences in outcomes after coronary artery bypass grafting (CABG) between women and men to provide strategies to optimize outcomes in women.Data to adequately inform coronary artery revascularization in women are limited. The initial data available to inform the treatment of women with coronary artery disease were based on randomized controlled trials that evaluated outcomes only in men. 1,2 Women have had lower rates of CABG compared with men (13%-16% in the late 1970s 3,4 ) to 29% in 2014. 5 In addition, there was a greater relative decline in the use of CABG in women between 1999 until 2014 (66% decline in women vs 60% in men). 5 Thus, treatment decisions for women with coronary artery disease have been based on data that are limited and may not be applicable, appropriate, or optimal.Fortunately, to ensure that the National Institutes of Health (NIH) is funding the highest quality science, the NIH now requires that rigor and transparency be addressed in every grant application submitted. This information requires a response to the consideration of relevant biological variables, including sex. The NIH states that "sex is a biological variable that is frequently ignored in animal studies and analyses, leading to an incomplete understanding of potential sex-based differences in basic biological function, disease processes and treatment response" and that "strong justification from the scientific literature, preliminary data, or relevant considerations be provided for applications proposing to study only one sex." 6 The goal of this requirement is to increase the use of female animals in basic science experiments as well as to increase the number of women enrolled in clinical trials to inform the best clinical care.

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“…С точки зрения полноценности реваскуляризации в условиях ОКС польза от ЧКВ и операции АКШ госпитальная смертность выше у женщин, чем у мужчин, независимо от стратегии реваскуляризации: 7,6% и 6,6% при ЧКВ при ОКСпST; 2,0% и 1,9% при ЧКВ при ОКСбпST; и 5,7% и 4,3% при АКШ при любом ОКС (p<0,001), что незначительно отличается от летальности при стабильной ишемической болезни сердца [37].…”

Section: акш у пациентов с оксбпStunclassified

Coronary artery bypass grafting in the treatment of patients with acute coronary syndrome: current evidence base and unresolved issues

2021

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The issue of the optimal timing of coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) remains controversial. It is known that on the one hand there will be a delay in revascularization, leading to recurrent myocardial infarction with irreversible cardiac dysfunction. On the other hand, there is an increased incidence of perioperative complications associated with surgery.This article provides a detailed analysis of the evidence base and current guidelines on the validity and timing of coronary artery bypass grafting in various types of ACS. The emphasis is made on the contradictions regarding the earlier implementation of the active strategy in non-ST segment elevation ACS. We describe problem of insufficient evidence base on optimal timing of CABG, comparison of outcomes of percutaneous coronary intervention (PCI) performed in the first 24 hours and open surgery for high-risk non-ST segment elevation ACS, as well as a number of organizational and clinical issues to ensure the surgery availability.

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Comparison of Outcomes of Coronary Revascularization for Acute Myocardial Infarction in Men Versus Women

Cited by 31 publications

References 28 publications

Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries

Coronary surgery in women: How can we improve outcomes

Coronary artery bypass grafting in the treatment of patients with acute coronary syndrome: current evidence base and unresolved issues

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