Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST‐Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)‐Retrospective Study

Abstract

BackgroundChina is experiencing a marked increase in ST‐segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in‐hospital death in relatively younger age groups (<70). Yet, little is known about sex differences in ST‐segment elevation myocardial infarction presentation and management.Methods and ResultsIn a nationally representative sample of patients with ST‐segment elevation myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006, and 2011, we examined sex differences in hospitalization rates, clinical profiles, and quality of care. Among 11 986 patients, the proportion of women was unchanged between 2001 and 2011. The estimated national rates of hospital admission per 100 000 people increased from 4.6 in 2001 to 18.0 in 2011 among men (3.9‐fold increase) and from 1.9 to 8.0 among women (4.2‐fold increase) (P trend<0.0001). The median age of women increased from 68 years in 2001 to 72 years in 2011 (P trend<0.001); however, there was no age change in men (63 years in 2011) (P trend=0.48). After accounting for age, women had a higher frequency of comorbidities. Although there were significant sex differences in the time interval of >12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence‐based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P<0.001 for all) and the differences were largely unchanged over time.ConclusionsWomen experienced a higher increase in hospitalization rates for ST‐segment elevation myocardial infarction in China between 2001 and 2011 and were less likely to receive evidence‐based therapies, especially reperfusion. In addition to efforts to improve quality of care generally, understanding the reasons for this sex disparity and addressing these differences in care should be a priority.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

“…These choices may affect the identification of AMI, STEMI or NSTEMI, and Charlson comorbidities, as well as PCI use. Third, given the nature of an administrative database, the NHDD lacks clinical information for AMI patients, such as ECG abnormalities and arrhythmia, which can be important in the diagnosis and classification of AMI 61, 62. Consequently, some of our classifications may be incorrect, which would alter the results.…”

“…Third, given the nature of an administrative database, the NHDD lacks clinical information for AMI patients, such as ECG abnormalities and arrhythmia, which can be important in the diagnosis and classification of AMI. 61,62 Consequently, some of our classifications may be incorrect, which would alter the results. In addition, some information about the exact time, such as when patients arrived at the hospital and had the first medical contact, were also unavailable but were important for doctors to choose the most appropriate treatment (eg, primary PCI or thrombolytic therapy) for STEMI patients.…”

“…First, although we controlled for multiple confounding factors, we cannot eliminate the possibility of unmeasured or unknown confounders affecting rates of IHM and PCI use for AMI patients. Second, different combinations of ICD-10 or ICD-9-CM codes were used to identify a disease or procedure in previous studies, such as our combination of I21 and I22 25,37,38,50 and I21 alone 24,60,61 for AMI and our combination of 00.66, 36.03 to 04, 36.06 to 07, and 36.09 39 or several different combinations of 00.66, 36.01 to 02, 36.05 to 07, and 36.09 16,25,51,53 for PCI. These choices may affect the identification of AMI, STEMI or NSTEMI, and Charlson comorbidities, as well as PCI use.…”

Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms

“…Many studies have proven that angina symptoms differ between men and women. [ 1 2 3 ] Men usually present typical symptoms whereas women most often present atypical angina symptoms. These discrepancies often lead to an increase in misdiagnosis rate in female patients.…”

“…[ 1 ] A large number of studies have proven that the epidemiology, clinical manifestations, and clinical prognosis of coronary artery disease (CAD) have sex-related differences. [ 1 2 3 4 5 6 ] In the past 30 years, the mortality of male patients with CAD has declined gradually, but an increase had been observed in women. [ 1 ] Unfortunately, accurate diagnosis of CAD might be more challenging in women than in men because women more frequently present with atypical symptoms.…”