Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (the Myocardial Infarction Triage and Intervention Registry)

Kudenchuk, Peter J.; Maynard, Charles; Martin, Jennifer; Wirkus, M; Weaver, W. Douglas

doi:10.1016/s0002-9149(96)00218-4

Cited by 258 publications

(150 citation statements)

References 17 publications

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“…Previous studies have shown that women are less likely to be considered for reperfusion therapy than men, in some cases even after adjusting for important clinical differences [17][18][19]. Despite the higher mortality rates in women, fewer women may receive major diagnostic and therapeutic procedures than men [20][21][22], even though women treated with early aggressive revascularization procedures may have a better long-term outcome than that of men [23].…”

Section: Discussionmentioning

confidence: 99%

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

Cohen

Gensini

Maritz

et al. 2005

J Thromb Thrombolysis

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Abstract. Background: The standard of care for STsegment elevation myocardial infarction (STEMI) is prompt coronary reperfusion with thrombolysis or percutaneous coronary intervention. Women have higher mortality rates than men following STEMI and fewer women are considered eligible for reperfusion therapy. We analyzed the impact of gender, and other factors, on the outcome and treatment of STEMI in the TETAMI trial and registry.Methods: This exploratory analysis included 2741 patients from Treatment with Enoxaparin and Tirofiban in Acute Myocardial Infarction (TETAMI) presenting with STEMI within 24 hours of symptom onset. The primary composite end point was the combined incidence of all-cause death, recurrent myocardial infarction, and recurrent angina, at 30 days. Three multivariate analyses were performed to determine predictors of not receiving reperfusion therapy, the composite end point, or death.Results: The triple end point occurred in 17.8% of women versus 13.3% of men. Reperfusion therapy was utilized in 38.2% of women versus 47.3% in men. However, age >75 years, delayed presentation, high systolic blood pressure (>100) and region (South Africa), were significant, independent predictors of not receiving reperfusion therapy. Significant predictors of the triple end point included not receiving reperfusion therapy, age >60 years, and higher Killip class. Predictors of death included age >60 years, low systolic blood pressure, higher Killip class, high heart rate, delayed presentation, and region (South Africa and South America).Conclusion: Female gender was not an independent predictor of outcome or underutilization of reperfusion therapy. Factors more common in female STEMI patients (advanced age and delayed presentation) were associated with not receiving reperfusion therapy and adverse outcome. Increased awareness is needed to reduce delayed presentation after symptom onset, especially among women.Abbreviated abstract. In this analysis of 2741 STsegment elevation myocardial infarction patients in the TETAMI trial and registry, a trend was observed for women being less likely to receive reperfusion therapy and more likely to have an adverse outcome than men. This was related to factors more common in female patients (advanced age and delayed presentation), and showed that an increased awareness is needed to reduce delayed presentation after symptom onset, especially among women.

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Section: Discussionmentioning

confidence: 99%

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

Cohen

Gensini

Maritz

et al. 2005

J Thromb Thrombolysis

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“…Previous studies have documented gender differences between men and women in procedure use and mortality among patients hospitalized with myocardial infarction, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] but few studies have assessed whether there are differences in processes and outcomes that require patient perceptions to measure. We found that women had worse health status outcomes than men, as indicated by worse physical and mental health, a greater likelihood of spending time in bed due to ill health, and a lower likelihood of returning to work 3 months after discharge; however, we found no differences in the quality of interpersonal communication or health behavior counseling for men and women.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Women hospitalized with myocardial infarctions are less likely to be treated with thrombolytics or revascularization. [1][2][3][4][5][6] Women also have a higher mortality rate following myocardial infarction, which may be partially explained by higher ages and increased comorbidity. [4][5][6][7][8][9][10][11][12][13][14][15] Despite this extensive literature comparing procedures and mortality in men and women with myocardial infarction, there is little information about patients' perceptions of processes and outcomes.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6] Women also have a higher mortality rate following myocardial infarction, which may be partially explained by higher ages and increased comorbidity. [4][5][6][7][8][9][10][11][12][13][14][15] Despite this extensive literature comparing procedures and mortality in men and women with myocardial infarction, there is little information about patients' perceptions of processes and outcomes. For example, little is known about processes of care that require patient reports to measure, such as the quality of communication during the hospitalization or at the time of discharge, or health education discussions with providers.…”

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confidence: 99%

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Differences in patient-reported processes and outcomes between men and women with myocardial infarction

et al. 2000

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OBJECTIVE:Previous research measuring differences in the care between men and women with myocardial infarction has focused on differences in procedure use and mortality. However, little is known about differences in processes and outcomes that are reported by patients, such as interpersonal processes of care and health status. Our goal was to measure differences in patient-reported measures for men and women who recently were hospitalized with myocardial infarction. PARTICIPANTS AND SETTING:We surveyed by mail patients with myocardial infarction discharged to home from one of 27 Cleveland area hospitals 3 months following discharge; 502 (64%) of 783 patients responded. The mean age of subjects was 65 years and 40% were women. D ifferences in treatment and survival have been consistently demonstrated for men and women with myocardial infarction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Women hospitalized with myocardial infarctions are less likely to be treated with thrombolytics or revascularization. 1-6 Women also have a higher mortality rate following myocardial infarction, which may be partially explained by higher ages and increased comorbidity. [4][5][6][7][8][9][10][11][12][13][14][15] Despite this extensive literature comparing procedures and mortality in men and women with myocardial infarction, there is little information about patients' perceptions of processes and outcomes. For example, little is known about processes of care that require patient reports to measure, such as the quality of communication during the hospitalization or at the time of discharge, or health education discussions with providers. In terms of outcomes, gender differences have seldom been examined in outcomes important to the quality of life of patients such as health status or employment status. MEASUREMENTS:Our goal was to measure differences in the processes and outcomes of care for men and women hospitalized for myocardial infarction, focusing on processes and outcomes that require patient reports. We surveyed patients in a community-based cohort 3 months after their myocardial infarction. We focused on 3 domains of process of care: quality of communication during the hospitalization, quality of communication at the time of discharge, and health education discussions. In addition, we measured several health care outcomes: physical and psychological health, bed days because of ill health, and employment status.

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Symptom Presentation of Women With Acute Coronary Syndromes

et al. 2007

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Background: Optimal diagnosis and timely treatment of patients with an acute coronary syndrome (ACS) depends on distinguishing differences between popular "myths" about ischemic symptoms in women and men. Chest pain or discomfort is regarded as the hallmark symptom of ACS, and its absence is regarded as "atypical" presentation. This review describes the presenting symptoms of ACS in women compared with men and ascertains whether women should have a symptom message that is separate or different from that for men. Methods: MEDLINE (1970-2005), bibliographies of articles, and pertinent abstracts were reviewed, focusing on studies of ACS presentation, especially those reporting differences in symptoms by sex. This analysis included 69 of 361 possible studies. Data regarding symptom presentation were recorded. Results: The published literature lacks standardization in characterizing ACS presentation, data collection, and reporting of symptoms. Approximately one-third of patients in the large cohort studies and one-quarter of patients in the smaller reports and direct patient interviews presented without chest pain or discomfort. The absence of chest pain or discomfort with ACS was noted more commonly in women than in men in both the cumulative summary from large cohort studies (37% vs 27%) and the single-center and small reports or interviews (30% vs 17%). Conclusions: Women are significantly less likely to report chest pain or discomfort compared with men. These differences, however, are not likely large enough to warrant sex-specific public health messages regarding the symptoms of ACS at the present time. Further research must systematically investigate sex differences in the clinical presentation of ACS symptoms and must include standardized data collection efforts.

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Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (the Myocardial Infarction Triage and Intervention Registry)

Cited by 258 publications

References 17 publications

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

Differences in patient-reported processes and outcomes between men and women with myocardial infarction

Symptom Presentation of Women With Acute Coronary Syndromes

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