Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention

Mehilli, Julinda; Kastrati, Adnan; Dirschinger, Josef; Pache, Jürgen; Seyfarth, Melchior; Blasini, R; Hall, Donald; Neumann, Franz‐Josef; Schömig, Albert

doi:10.1001/jama.287.2.210

Cited by 144 publications

(83 citation statements)

References 42 publications

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“…Similar to previous studies, [1][2][3][4][5][6][7][8][9][10][11] women were older than men by 8 years on average and had a lower body surface area, a higher Killip class, and higher incidences of hypertension, diabetes mellitus, and hyperlipidemia. On coronary angiography, the extent of underlying coronary atherosclerosis, evaluated on the basis of the number of diseased vessels, did not differ between women and men, consistent with the findings of previous investigations.…”

Section: Discussionsupporting

confidence: 81%

“…11 Mehilli et al showed that women with AMI who received percutaneous coronary intervention have outcomes similar to those of men, despite more adverse risk profiles. 3 Differences in study design, entry criteria, and length of follow-up make it difficult to compare results in different studies. The present study included high-risk patients who are usually excluded from clinical trials, such as those who are elderly and have shock, as well as a high proportion of patients with diabetes mellitus (31%).…”

Section: Discussionmentioning

confidence: 99%

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Sex Differences in Early Mortality of Patients Undergoing Primary Stenting for Acute Myocardial Infarction

Kosuge

Kimura

Kojima

et al. 2006

Circ J

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number of studies have addressed sex-related differences in outcomes in patients with acute myocardial infarction (AMI). A few studies have reported similar or lower mortality rates after AMI in women than in men, 1-4 but most have concluded that mortality is higher in women irrespective of reperfusion modality. [5][6][7][8][9][10][11][12] The reasons for poorer outcomes in women remain unclear. Increased mortality in women might be Circulation Journal Vol. 70, March 2006 partially explained by their higher age at presentation and higher risk profiles. Some, [5][6][7][8] but not all, 9-12 studies have shown that female gender itself is independently associated with increased mortality after adjustment for baseline differences. One potential explanation for the persistence of increased mortality after risk adjustment is that women frequently receive less aggressive treatment for AMI than men. 7,13,14 Primary balloon angioplasty, compared with thrombolytic therapy, has been shown to improve outcomes for women, but mortality remains high. 2,10 Limited information exists regarding the impact of sex on outcomes after contemporary interventional techniques, such as stent implantation, for AMI. We therefore analyzed a database from a large, retrospective, multicenter observational study of patients with AMI who underwent emergency primary stenting to assess the outcomes of women compared with those of men. Methods PatientsThe patients included in the current study were selected from those enrolled into the Japan Acute Coronary Syndrome Study, 15 a retrospective, observational multicenter trial. Between January 2001 and December 2003, patients who were admitted to 35 participating hospitals in Japan within 48 h after the onset of AMI were studied. A diagnosis of AMI required at least 2 of the following characteristics: typical chest pain persisting for 30 min or longer, Background Limited information exists regarding the impact of gender on in-hospital outcome after primary stenting for acute myocardial infarction (AMI). Methods and Results A total of 2,981 patients (790 women and 2,191 men) participated in the study who were admitted within 24 h after symptom onset and underwent emergency primary stenting for AMI. Compared with men, women were significantly older; had higher incidences of hypertension, diabetes mellitus, hyperlipidemia, Killip class ≥2, and cardiogenic shock; had a higher blood glucose level and a lower serum creatinine level on admission. Other baseline characteristics, including the incidences of ST-segment elevation AMI, anterior infarction, 3-vessel disease, initial or final Thrombolysis in Myocardial Infarction (TIMI) flow grade did not significantly differ between the sexes. The in-hospital mortality rate was significantly higher in women than in men (9.4% vs 5.2%, p<0.001). On multivariate analysis, age, Killip class, blood glucose level, serum creatinine level, and final TIMI grade were independent predictors of in-hospital death, but female gender was not (odds ratio 1.01, p=0.69). Conclusi...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Sex Differences in Early Mortality of Patients Undergoing Primary Stenting for Acute Myocardial Infarction

Kosuge

Kimura

Kojima

et al. 2006

Circ J

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“…In contrast to virtually all reports in medical literature, Mehilli et al 30 found similar mortality rates for both genders and, when values were age-adjusted, they found a smaller mortality rate among women. But this study differs from ours in many aspects.…”

Section: Gender Influence On the Immediate And Medium-term Progressiomentioning

confidence: 57%

Influência do sexo na evolução imediata e a médio prazo após a intervenção coronariana percutânea primária e análise dos fatores independentes de risco para óbito ou eventos

Peixoto¹,

Peixoto²,

Sena³

et al. 2006

Arq. Bras. Cardiol.

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OBJECTIVEDetermine gender-related differences and risk factors for death and events, both in-hospital and at six-month evolution, of patients admitted within the fi rst twelve hours of ST-segment elevation acute myocardial infarction and who underwent primary percutaneous coronary intervention. METHODSBetween July 1998 and December 2000, 199 consecutive patients were enrolled in the study, with elevation myocardial infarction and without cardiogenic shock, outcome, in-hospital and six-month progression were studied. RESULTSClinical characteristics were similar in both groups, except that women were older than men (67.04 ± 11.53 x 59.70 ± 10.88, p < 0.0001). In-hospital mortality was higher among women (9.1% x 1.5%, p = 0.0171), as was the incidence of major events (12.1% x 3.0%, p = 0.0026). The difference in mortality rates remained the same at six months (12.1% x 1.5%, p = 0.0026). The multivariate analysis predicted death: female gender and an age over eighty years, and major events and/or stable angina multivessel: disease and severe ventricular dysfunction. CONCLUSIONFemale gender and an age over eighty years were independent predictors of mortality, six months of patients who had undergone primary percutaneous intervention. KEY WORDSPrimary coronary angioplasty, acute myocardial infarction, gender, risk factors.

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“…Recently, in Germany, Mehilli et al 20 , analyzing 1937 patients with acute myocardial infarction treated with mechanical reperfusion, reported a 1-year mortality similar for both sexes, despite the more advanced age and the higher prevalence of diabetes mellitus and systemic arterial hypertension in females. According to the latter authors, maybe due to particularities in the selection of patients, the greater mortality in acute myocardial infarction in females, even on univariate analysis, was not statistically significant, and, therefore, sex seems not to be an indicator of mortality after the first episode of infarction.…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

Dg¹,

Pj²,

Jn³

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To identify the clinical and demographic predictors of in-hospital mortality in acute myocardial infarction with elevation of the ST segment in a public hospital, in the city of Fortaleza, Ceará state, Brazil. METHODS: A retrospective study of 373 patients experiencing their first episode of acute myocardial infarction was carried out. Of the study patients, 289 were discharged from the hospital (group A) and 84 died (group B). Both groups were analyzed regarding: sex; age; time elapsed from the beginning of the symptoms of myocardial infarction to assistance at the hospital; use of streptokinase; risk factors for atherosclerosis; electrocardiographic location of myocardial infarct; and Killip functional class. RESULTS: In a univariate analysis, group B had a greater proportion of the following parameters as compared with group A: non-Killip I functional class; diabetes; age >70 years; infarction of the inferior wall associated with right ventricular impairment; time between symptom onset and treatment at the hospital >12 h; anteroseptal or extensive anterior infarction; no use of streptokinase; and no tobacco use. In a multivariate logistic regression analysis, only non-Killip I functional class, diabetes, and age >70 years persisted as independent factors for death. CONCLUSION: Non-Killip I functional class, diabetes, and age >70 years were independent predictors of mortality in acute myocardial infarction with elevation of the ST segment

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Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention

Cited by 144 publications

References 42 publications

Sex Differences in Early Mortality of Patients Undergoing Primary Stenting for Acute Myocardial Infarction

Sex Differences in Early Mortality of Patients Undergoing Primary Stenting for Acute Myocardial Infarction

Influência do sexo na evolução imediata e a médio prazo após a intervenção coronariana percutânea primária e análise dos fatores independentes de risco para óbito ou eventos

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

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