Sex Differences in the Treatment and Outcome of Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Population-Based Study

Lin, Chien-Chen; Shen, Li‐Jiuan; Hsiao, Fei‐Yuan; Gau, Churn-Shiouh; Wu, Fe-Lin Lin

doi:10.1089/jwh.2013.4474

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…Patient clinical status was assessed by the Multisource Comorbidity Score (MCS) [19], a comorbidity index that has been shown to predict mortality and other clinical outcomes in the Italian population better than other commonly used comorbidity scores. Four comorbidity profile categories were established: good (MCS: 0-4), intermediate (5)(6)(7)(8)(9), poor (10)(11)(12)(13)(14), and very poor (≥15).…”

Section: Cohort Baseline Characteristicsmentioning

confidence: 99%

“…However, few studies have investigated differences in the out-of-hospital management of ACS between men and women, and those that have evaluated drug treatment and long-term prognosis observed conflicting findings [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…‡ Comorbidity and Multisource Comorbidity Score both measured according to hospital admission and drug prescriptions experienced five years before the date of index admission.† Multisource Comorbidity Score is a comorbidity index obtained from inpatient diagnostic information and outpatient drug prescriptions, validated using Italian data. Four categories of clinical profiles were considered: good (MCS: 0-4), intermediate(5)(6)(7)(8)(9), poor(10)(11)(12)(13)(14) or very poor (≥15). * According to the chi-square test or its version for the trend.…”

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confidence: 99%

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Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation

Ronco

Rea

Filippelli

et al. 2023

JCM

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At the time of first acute coronary syndrome (ACS) hospital admission, women are generally older and have more comorbidities than men, which may explain differences in their short-term prognosis. However, few studies have focused on differences in the out-of-hospital management of men and women. This study investigated (i) the risk of clinical outcomes, (ii) the use of out-of-hospital healthcare and (iii) the effects of clinical recommendations on outcomes in men vs. women. A total of 90,779 residents of the Lombardy Region (Italy) were hospitalized for ACS from 2011 to 2015. Exposure to prescribed drugs, diagnostic procedures, laboratory tests, and cardiac rehabilitation in the first year after ACS hospitalization were recorded. To evaluate whether sex can modify the relationship between clinical recommendations and outcomes, adjusted Cox models were separately fitted for men and women. Women were exposed to fewer treatments, required fewer outpatient services than men and had a lower risk of long-term clinical events. The stratified analysis showed an association between adherence to clinical recommendations and a lower risk of clinical outcomes in both sexes. Since improved adherence to clinical recommendations seems to be beneficial for both sexes, tight out-of-hospital healthcare control should be recommended to achieve favourable clinical benefits.

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Section: Cohort Baseline Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation

Ronco

Rea

Filippelli

et al. 2023

JCM

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“…Furthermore, differences in insurance type seem to cause disparities in the outcome of patients with ACS [ 20 – 24 ]. However, there remains a lack of available evidence regarding sex-based differences in this context [ 25 ]. To our knowledge, such study to examine post-NHI implementation’s outcome in patients with ACS has never been done in Indonesia.…”

Section: Introductionmentioning

confidence: 99%

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

Qalby,

Arsyad,

Qanitha

et al. 2024

BMC Health Serv Res

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Background The National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS). Methods This is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis. Results We observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001). Conclusions This study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC.

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“…Although young women had less obstructive CHD, survival was worse compared with similarly aged men. Lin et al 14 carried out a retrospective cohort study of patients who underwent PCI (8884 women and 23 937 men) and found that male sex was associated with a higher risk of rehospitalization for revascularization than female sex. Some studies evaluated PCI procedure success in women compared with men.…”

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confidence: 99%

Menopause Status and Percutaneous Coronary Intervention

Kolovou

Mavrogeni

2015

Angiology

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The age at natural menopause (ANM) is considered as an independent risk factor for morbidity and mortality and indicates the transition from a low to a higher risk of coronary heart disease (CHD) in women. 1 The World Health Organization has defined natural menopause as minimum 12 consecutive months of amenorrhea occurring without any surgical intervention or other pathological causes. 2,3 In the West industrialized populations, the mean ANM is 51 years, and in poor and nonindustrialized populations it is 48 years. observed that the prevalence of early menopause in these women was 25%.The menopause results in reduced production of estrogens as well as increased levels of follicle-stimulating hormone. Besides the genetic effect on the timing of ANM 5 and mother's age at menopause, 5 environmental factors such as cigarette smoking, 6,7 nulliparity, 8 and adult socioeconomic position play a role in determining the ANM 9,10 Cigarette smoking and socioeconomics are also associated, independent of the menopause, with risk factors for cardiovascular (CV) disease.Zhang et al 4 investigated the frequency of major adverse CV events (MACEs) in women who underwent PCI according to the ANM. The authors found that early menopause women compared with normal menopause women were younger, had additional comorbidities, and more severe lesions. Furthermore, early ANM was independently associated with the risk of MACEs mainly driven by the risk of target lesion revascularization. Studies that compared the outcomes of women after stenting angioplasty and ANM are limited; thus, the results cannot be compared with other similar studies. Nevertheless, there are studies that evaluated the influence of early menopause on premature CHD. For example, Lubiszewska et al 11 have shown that smoking and early postmenopausal stage (3 years) are the most important determinants of premature CHD in women.However, most studies compared (with conflicting results) PCI CV outcomes between men and women. Funakoshi et al 12 evaluated Japanese patients (2845 women and 6843 men undergoing first coronary revascularization; PCI or coronary artery bypass grafting) and found that the coronary risk factor burden appeared greater in women than in men, despite the fact that women had a lower incidence of repeated revascularization compared with men. Otten et al 13 studied 4991 men and 1755 women admitted to the hospital for PCI. Patients were stratified into 2 groups, <65 years (young group) and 65 years (elderly). They found that the differences in mortality between men and women were age dependent. Although young women had less obstructive CHD, survival was worse compared with similarly aged men. Lin et al 14 carried out a retrospective cohort study of patients who underwent PCI (8884 women and 23 937 men) and found that male sex was associated with a higher risk of rehospitalization for revascularization than female sex.Some studies evaluated PCI procedure success in women compared with men. Prior studies have suggested that PCIs in women were less successful ...

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Sex Differences in the Treatment and Outcome of Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Population-Based Study

Cited by 9 publications

References 43 publications

Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation

Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

Menopause Status and Percutaneous Coronary Intervention

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