Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Abstract

BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients. OBJECTIVES: To identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients. DESIGN: Retrospective analysis. SETTINGS: Hospitals across Malaysia. PATIENTS AND METHODS: We analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender. MAIN OUTCOME MEASURES: Differential risk factors for each gender. RESULTS: For the 19 484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P<.001). The univariate analysis showed that the majority of male patients <65 years while females were ≥65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group. CONCLUSION: Gender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI. LIMITATION: Retrospective registry data with inter-hospital variation. C oronary artery disease (CAD) is the number one cause of mortality and morbidity in Malaysia and globally for both males and females. 1,2 Even worse, CAD has remained the principal cause of death for the ten years from 2005 to 2014. 3 In CAD, which is also known as ischemic heart disease, a waxy substance called plaque builds up inside the coronary arteries. 4 CAD, traditionally considered a male disease, is also a major threat to females nowadays. In general, females

Association of Gender With Stent Thrombosis and Short-Term Major Adverse Cardiovascular Events in Patients Undergoing Primary Percutaneous Coronary Intervention

“…Hence, the gender of patients itself does not determine the prognosis of the patient, but longer ischemic time, older age, and consequently higher burden of risk factors confound the effect of the female gender as observed by various studies in the past. [5][6][7][8][9]23 One of the major determinants of adverse outcomes in patients with STEMI is the pre-hospital delays. The timeline in the management of STEMI is different in females compared to their male counterparts, females experience longer gaps not only in symptoms to hospital arrival but also from hospital arrival to the procedure time, causing a delay in the reinstatement of myocardium on time.…”

“…Different researches have been conducted that show female gender is linked to the increased risks of immediate and longterm death following cardiovascular events. [4][5][6][7][8][9][10][11] However, there is a contradiction of evidence because there are plenty of studies showing no variances in results or attributed differences in outcomes to the variations in baseline features such as a higher burden of comorbidities in females owing to advanced age at the time of presentation. 12,13 Multiple factors associated with an increased rate of severe events in females have been depicted by studies centering on outcomes of gender disparities, such as some studies have shown that females are more likely to have the atypical medical presentation and prehospital delays than males leading to delay in reperfusion therapy.…”