Sex Differences in Management and Outcome After Acute Myocardial Infarction in the 1990s

Gottlieb, Shmuel; Harpaz, David; Shotan, Avraham; Boyko, Valentina; Leor, Jonathan; Cohen, Miriam; Mandelzweig, Lori; Mazouz, Benjamin; Stern, Shlomo; Behar, Solomon

doi:10.1161/01.cir.102.20.2484

Cited by 146 publications

(92 citation statements)

References 32 publications

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“…Momenuzzaman 7 did not observe any sex differential in terms of diabetes mellitus, while Hanratty et al 11 found a low prevalence of diabetes mellitus in both sexes (female 16%vs male 11%).Regarding hypertension, no significant difference was observed between the groups (female 42%, male 39%, p=0.666) bearing consistency with findings of Momenuzzma 7 . However, the findings differ from those reported by Gottlieb et al 9 and Jiang et al 10 who found a significantly higher prevalence of hypertension in females compared to males.Females had a higher incidence of hyperlipidemia as opposed to males (45% vs 32%, p=0.040). Similar results were also reported by others.…”

Section: Discussioncontrasting

confidence: 87%

“…Similar smoking behaviour was observed in the studies conducted by others. 7,9,10 Diabetes mellitus was considerably higher in female patients (39%) than that in male patients (24%) which is consistent with Gottlieb et al 9 and Jiang et al 10 . Momenuzzaman 7 did not observe any sex differential in terms of diabetes mellitus, while Hanratty et al 11 found a low prevalence of diabetes mellitus in both sexes (female 16%vs male 11%).Regarding hypertension, no significant difference was observed between the groups (female 42%, male 39%, p=0.666) bearing consistency with findings of Momenuzzma 7 .…”

Section: Discussionsupporting

confidence: 75%

“…Comparison of use ofâ-blockers showed it was underused in females (63%) compared to males (75%) which is statistically significant (p=0.046).This finding is consistent with previous reports. 9,10,[12][13][14][15] The significant underuse of â-blockers in female patients in our study may be explained by the fact that more females had diabetes mellitus and congestive heart failure. International data support the fact that despite recommendations in favour of use of â-blockers, these are still underused in post-infarct patients, at the expense of many lives lost 17 .…”

Section: Discussionmentioning

confidence: 67%

“…Similar results were also reported by others. 9,10,12 Regarding treatment with reperfusion, in our series, we used Streptokinase for reperfusion therapy within 12 hours of symptom onset in cases of eligible STEMI patients. Streptokinase was significantly underused in females (15.6%) compared to males (32.2%) (p=0.011).Underuse of reperfusion therapy was also reported in other studies.…”

Section: Discussionmentioning

confidence: 99%

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Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

et al. 2018

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Abstract:Background: In-hospital mortality in female patients with acute myocardial infarction (AMI) and factors affecting this may be different from those of their male counterpart. The aim of the current study was to compare the in-hospital mortality between female and male patients with AMI and to compare the differences in age, risk factors, treatment given and complications between them. Methods: Total 200 nonrandomised patients with a definite diagnosis of AMI admittedover a period of one year (January 2008 -December 2008) were enrolled in the study, in which 100 female patients were considered as cases and 100 male patients as controls. Both groups were studied prospectively.Datawere collected in prefixed questionnaire and data sheet and were analysed using SPSS software.Results: mean age of the female patients was significantly higher than that of their male counterpart (57.0±10.1 years and 53.3±10.3 years respectively, p=0.029). Diabetes mellitus and hyperlipidemia were significantly higher in females than those in males (39% vs 24%, p=0.022 and 45% vs 32%, p=0.040 respectively), while smoking was staggeringly higher among the males (59%) compared to the females (4%) (p<0.001).However, no significant difference was observed between the groups in terms of hypertension (p=0.666).Pre-hospital delay (more than 12 hours after onset of chest pain) was significantly higher in the female group than that in the male group (72% vs 58%,p=0.038). Streptokinase was significantly underused in females (15.6%) compared to that used in males (32.2%) (p=0.011). The use of b-receptor blockerswas also significantly less in females than that in males (63% vs 75%, p=0.046).Death was significantly higher in the females (21%) than that in the males (10%) (p=0.032). Unstable angina, re-infarction and congestive heart failure were somewhat higher in the female subjects compared to their male counterparts (40% vs 34%, 2% vs 1% and 32% vs 23% respectively) though the differences did not seem significant (p=0.380, p=0.561 and p=0.154 respectively). Arrhythmias did not differ significantly between the groups (p 1 >0.05).Conclusion: Female patients with AMI had significantly higher in-hospital mortality. Early hospitalization and optimal treatment are crucial to decrease mortality in female patients.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

et al. 2018

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“…However in this study, the strongest predictors of not receiving reperfusion therapy were advanced age, delayed presentation, high systolic blood pressure and geographic region (South Africa). Previous studies have shown that women are less likely to be considered for reperfusion therapy than men, in some cases even after adjusting for important clinical differences [17][18][19]. Despite the higher mortality rates in women, fewer women may receive major diagnostic and therapeutic procedures than men [20][21][22], even though women treated with early aggressive revascularization procedures may have a better long-term outcome than that of men [23].…”

Section: Discussionmentioning

confidence: 99%

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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Management and Outcomes of Elderly Women and Men With Acute Coronary Syndromes in 2000 and 2002

Moriel¹,

Behar²,

Tzivoni³

et al. 2005

Arch Intern Med

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In the 2000s, elderly women and men with ACSs are receiving similar medical and invasive management during the index hospitalization; however, women with STE-ACS have higher mortality rates at 7 days but not at 6 months. Mortality rates are highest in patients with STE-ACS denied coronary angiography. The benefit of invasive procedures on mortality rates in elderly patients with STE-ACS needs further investigation.

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Sex Differences in Management and Outcome After Acute Myocardial Infarction in the 1990s

Cited by 146 publications

References 32 publications

Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

Study of Gender-based In-Hospital Mortality Difference in Patients with Acute 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

Management and Outcomes of Elderly Women and Men With Acute Coronary Syndromes in 2000 and 2002

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