Meta-Analysis of Gender Disparities in In-hospital Care and Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

Shah, Tayyab; Haimi, Ido; Yang, Yiping; Gaston, Samantha; Taoutel, Roy; Mehta, Sameer; Lee, Hyon Jae; Zambahari, Robaayah; Baumbach, Andreas; Henry, Timothy D.; Grines, Cindy L.; Lansky, Alexandra J.; Tı̂rziu, Daniela

doi:10.1016/j.amjcard.2021.02.015

Cited by 45 publications

(45 citation statements)

References 34 publications

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“…The doctors need to be trained and ready to understand the symptoms of heart disease in women, be able to assess the risks, and expediently provide care that could possibly save her life [ 13 ].…”

Section: A Better Way Forwardmentioning

confidence: 99%

The Future of Women and Heart Disease in a Pandemic Era: Let’s Learn from the Past

Steinbaum

2021

Medicina

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When the pandemic started in February, about 5 million women were running businesses. Just 2 months later, 25% of those businesses closed. Approximately 2.5 million women have lost their jobs or dropped out of the workforce since the pandemic, but that is just the start of the impact on women. Women have been disproportionately affected by the pandemic, as the brunt of homelife has fallen on them, and the psychosocial impact will inevitably have a physical impact. The pandemic has revealed the gender inequality that exists from the socioeconomic perspective, but soon we will see the impact from the medical perspective. Predictably, we know that the impact of stress and lack of self-care that women have had to endure heightens heart disease, already the number one killer of all women. Heart disease is 80% preventable based on the major risk factors: high cholesterol, high blood pressure, elevated sugar, obesity, smoking, sedentary lifestyle, and poor diet. But the psychological risk factors drive up biomarkers and the root causes of manifesting disease. Historically, women have been less diagnosed and treated, and less likely to receive lifesaving care in a timely fashion. The pandemic is sure to amplify these issues. Without mitigation and prevention, women’s hearts will suffer. We need to be aware of this now to prepare for the future potential of a significant increase in the incidence of women and heart disease.

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Section: A Better Way Forwardmentioning

confidence: 99%

The Future of Women and Heart Disease in a Pandemic Era: Let’s Learn from the Past

Steinbaum

2021

Medicina

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“…However, sex disparities in CAD outcomes persist, as women are more often underdiagnosed or delayed in diagnosis (3,4), receive less guideline-based treatment (5,6), and are not included proportionately in clinical trials (7). Women more often have pre-hospital delay in presentation after chest pain onset (by ∼30-45 min compared to men) (3,8,9). Compared to men, women are underdiagnosed for myocardial infarction, less likely to undergo coronary angiography, and less likely to receive therapies such as revascularization and mechanical circulatory support (8,(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…Women more often have pre-hospital delay in presentation after chest pain onset (by ∼30-45 min compared to men) (3,8,9). Compared to men, women are underdiagnosed for myocardial infarction, less likely to undergo coronary angiography, and less likely to receive therapies such as revascularization and mechanical circulatory support (8,(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…Excess mortality in women appear to be driven by age, as women are older with more co-morbidities which may contribute to delays in aggressive treatment, and lower preventive therapy compared to men ( 4 , 5 ). In a recently published large meta-analysis of 705,098 patients with STEMI (31% women), women had higher in-hospital mortality (OR 1.91), repeat myocardial infarction (OR 1.25), stroke (OR 1.67), and major bleeding (OR 1.82) compared to men ( 8 ). Furthermore, women more often have no obstructive CAD in the setting of acute coronary syndrome (ACS), NSTEMI, and STEMI ( Figure 1 ), ( 14 ) potentially contributing to diagnostic and therapeutic equipoise.…”

Section: Introductionmentioning

confidence: 99%

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Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine

Mehta

Wei

Shufelt

et al. 2021

Front. Cardiovasc. Med.

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Coronary artery disease (CAD) is the leading cause of morbidity and mortality among both women and men, yet women continue to have delays in diagnosis and treatment. The lack of recognition of sex-specific biological and socio-cultural gender-related differences in chest pain presentation of CAD may, in part, explain these disparities. Sex and gender differences in pain mechanisms including psychological susceptibility, the autonomic nervous system (ANS) reactivity, and visceral innervation likely contribute to chest pain differences. CAD risk scores and typical/atypical angina characterization no longer appear relevant and should not be used in women and men. Women more often have ischemia with no obstructive CAD (INOCA) and myocardial infarction, contributing to diagnostic and therapeutic equipoise. Existing knowledge demonstrates that chest pain often does not relate to obstructive CAD, suggesting a more thoughtful approach to percutaneous coronary intervention (PCI) and medical therapy for chest pain in stable obstructive CAD. Emerging knowledge regarding the central and ANS and visceral pain processing in patients with and without angina offers explanatory mechanisms for chest pain and should be investigated with interdisciplinary teams of cardiologists, neuroscientists, bio-behavioral experts, and pain specialists. Improved understanding of sex and gender differences in chest pain, including biological pathways as well as sociocultural contributions, is needed to improve clinical care in both women and men.

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“…Additionally, as shown by Shah et al in their meta-analysis of 56 studies on in-hospital management in STEMI (705,098 patients, including 31% women), in-hospital mortality was higher in women than in men. Additionally, higher frequencies of repeated myocardial infarction, stroke, and major bleeding were found in the group of women [ 14 ]. In turn, Eindhoven et al in a large study involving 59,534 patients, found significant differences in the prognosis for women compared to men, resulting from the tendency for non-compliance with medical recommendations among the women [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019

Sielski

Kaziród-Wolski

Jurys³

et al. 2021

JCM

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Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). Results: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59–1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. Conclusions: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences.

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Meta-Analysis of Gender Disparities in In-hospital Care and Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

Cited by 45 publications

References 34 publications

The Future of Women and Heart Disease in a Pandemic Era: Let’s Learn from the Past

The Future of Women and Heart Disease in a Pandemic Era: Let’s Learn from the Past

Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine

The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019

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