Effect of gender on outcomes of acute coronary syndromes

Hasdai, David; Porter, Avital; Rosengren, Annika; Behar, Solomon; Boyko, Valentina; Battler, Alexander

doi:10.1016/s0002-9149(03)00400-4

Cited by 97 publications

(80 citation statements)

References 7 publications

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“…In general, women have a higher mortality rate, whether or not they receive reperfusion therapy, compared with men. These results parallel those of previous studies that also show that women with acute myocardial infarction have a worse prognosis than men [5,11,12], even beyond 1 year [13,14].…”

Section: Discussionsupporting

confidence: 91%

“…Similar findings to ours regarding in-hospital mortality were reported in a prospective registry of 9589 European patients with acute coronary syndromes, although this gender difference was eliminated after adjusting for age and other confounding factors [12]. Data from the North American National Registry of Myocardial Infarctions 2 (NRMI 2) showed that, of the 384 878 patients surviving to reach hospital after an acute myocardial infarction, age was an important potential factor for excess mortality in women [5].…”

Section: Discussionsupporting

confidence: 78%

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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: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 78%

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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“…Campbell et al [16] compared the histological structure of the myocardium and coronary microvasculature of men and women and found differences in the arterioles wall and the ratio of the cardiac myocyte and body surface area that can justify the presence of ischemic symptoms in more frequent in females, although not always correlating with more severe coronary artery disease than in males. Hasdai et al [17] assessed the outcome of 10,000 patients after ACS in relation to gender and observed in this record that females had older age, no association with increased mortality, lower use of antiplatelet agents (such as glycoprotein IIbIIIa) and less use of less beta blockers, antiplatelet and statin, and more diuretics and digoxin at discharge [17]. Although studies suggest female as a risk indicator for CABG and being part of the scores [18], others did not confirm this risk in the context of ACS [19][20][21], as well as the present study.…”

Section: Discussionmentioning

confidence: 99%

Unstable angina does not increase mortality in coronary artery bypass graft surgery

Sussenbach¹,

Guaragna²,

Castagnino³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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391Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):391- 392Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(3):391-400 Sussenbach CP, et al. -Unstable angina does not increase mortality in coronary artery bypass graft surgery twenty minutes (if not interrupted by the nitroglycerin), 2) is described as an intense and frank pain and recent onset (less than 1 month), 3) occurs in a crescendo pattern (e.g., more intense, prolonged or frequent than previously), in the absence signs of myocardial necrosis (elevation of cardiac enzymes). On the ohter hand, the European System Risk in Cardiac Operations (EuroSCORE) defines UA as anginal pain at rest that requires treatment with intravenous nitroglycerin to the surgical procedure. For purposes of this study UA was defined as acute coronary syndrome without ST elevation (ACSST) and without enzyme and/or class IV angina [6,7]. RevAccording to current recommendations on UA, taking into account the patient's risk, CABG is indicated in cases of severe injury of the left main coronary artery, threevessel disease with impaired left ventricular function (left ventricular ejection fraction < 0.5 ); two-vessel lesion with involvement of the proximal left anterior descending artery or decreased left ventricular function or provoked ischemia. Life expectancy, associated diseases, symptom severity and amount of viable myocardium at risk are also important factors [5,8,9].

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“…1,6,12) No influence of gender on mortality was detected by our multivariate analysis, which correlates with other papers. 20,21) Some other studies reported female gender to be a firm risk factor of death 22,23) although studies conducted on larger cohorts and involving different populations should be compared carefully. The same multivariate analysis showed that dyslipidemia influences the risk of death by a decrease in its level.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Myocardial Infarction Time Course in Women Compared With Men in Upper Silesia Population in 30 Day Follow-Up

et al. 2009

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SummaryThe aim of the study was to compare the course of myocardial infarction in women versus men in Upper Silesia, an industrial region in the south of Poland.The study comprised 1003 patients with either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). The patients were divided into group 1 (300 females) and group 2 (control, 703 males). The groups differed significantly with respect to age, incidence of hypertension, diabetes, and smoking. In group 1 STEMI occurred significantly less frequently than NSTEMI. Taking this into account, we divided the studied cohort into group A (STEMI patients) and group B (NSTEMI patients), each subdivided into women and men.In the 30 day long follow-up, group 1 patients had significantly lower creatine kinase activity, higher occurrence of ventricular tachycardia, lower percentage of intra-aortic balloon pump use, and longer hospital stay compared with group 2. Group 1 was characterized by significantly higher mortality and target lesion reocclusion (TLR).The medical course of myocardial infarction in women is similar to that in men, as is the treatment of acute coronary syndrome. In our study, patients from both groups underwent invasive examination with consecutive interventional treatment with similar frequency. However, this finding is not reflected in the outcomes. Women had higher risks of death and TLR in 30 day follow-up. Taking this into consideration, we should attempt to identify the factors responsible for this situation by expanding the analysis to a larger population to allow firm conclusions to be drawn. (Int Heart J 2009; 50: 711-721)

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Effect of gender on outcomes of acute coronary syndromes

Cited by 97 publications

References 7 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

Unstable angina does not increase mortality in coronary artery bypass graft surgery

Analysis of Myocardial Infarction Time Course in Women Compared With Men in Upper Silesia Population in 30 Day Follow-Up

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