Acute myocardial infarction in women: Contribution of treatment variables to adverse outcome

Barakat, Khalid; Wilkinson, Paul; Suliman, A; Ranjadayalan, Kulasegaram; Timmis, Adam

doi:10.1067/mhj.2000.110089

Cited by 94 publications

(45 citation statements)

References 25 publications

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“…4 -8 Although some have found that the treatment differences are small and do not affect early death, 17 others have attributed the sex gap in death after AMI to these treatment inequalities. 5,8 Thus, the extent to which mortality rate differences between men and women are related to discrepancies in baseline risk versus treatment bias remains a matter of constant debate. The controversy in the literature stems largely from differences in the studied populations and from methodological variations, including differences in definitions and adjustment analyses.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

et al. 2008

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“…1 Less frequent use of revascularization procedures in women also may account for some of the excess mortality. Indeed, findings from large database studies [2][3][4][5][6][7][8][9][10][11] have indicated that women with acute myocardial infarction tend to undergo less aggressive hospital management than men. However, the relation of lower rates of revascularization is debated: Some studies have found that the excess mortality in women was explained by older age and higher baseline risk [12][13][14][15][16][17] or that it was restricted to a subgroup of female patients, whereas others have suggested that undertreatment in women had no effect on early mortality from acute myocardial infarction.…”

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confidence: 99%

Gender Differences in Hospital Mortality and Use of Percutaneous Coronary Intervention in Acute Myocardial Infarction

et al. 2007

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Background-Women with acute myocardial infarction have a higher hospital mortality rate than men. This difference has been ascribed to their older age, more frequent comorbidities, and less frequent use of revascularization. The aim of this study is to assess these factors in relation to excess mortality in women. Methods and Results-All hospital admissions in France with a discharge diagnosis of acute myocardial infarction were extracted from the national payment database. Logistic regression on mortality was performed for age, comorbidities, and coronary interventions. Nonparametric microsimulation models estimated the percutaneous coronary intervention and mortality rates that women would experience if they were "treated like men." Data were analyzed from 74 389 patients hospitalized with acute myocardial infarction, 30.0% of whom were women. Women were older (75 versus 63 years of age; PϽ0.001) and had a higher rate of hospital mortality (14.8% versus 6.1%; PϽ0.0001) than men. Percutaneous coronary interventions were more frequent in men (7.4% versus 4.8%; 24.4% versus 14.2% with stent; PϽ0.001). Mortality adjusted for age and comorbidities was higher in women (PϽ0.001), with an excess adjusted absolute mortality of 1.95%. Simulation models related 0.46% of this excess to reduced use of procedures. Survival benefit related to percutaneous coronary intervention was lower among women. Conclusions-The difference in mortality rate between men and women with acute myocardial infarction is due largely to the different age structure of these populations. However, age-adjusted hospital mortality was higher for women and was associated with a lower rate of percutaneous coronary intervention. Simulations suggest that women would derive benefit from more frequent use of percutaneous coronary intervention, although these procedures appear less protective in women than in men.

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“…Accumulating literature evidence showed that women receive less medical and invasive treatments after AMI compared with men (15,17,21) . On the other hand, other investigators showed that in a sample of population included patients admitted with AMI for the first time without significant stenosis based on diagnostic heart catheterization, women were found to share the same prospects as men regarding long-term prognosis and the extent of secondary preventive medical treatment (23) .…”

Section: Discussionmentioning

confidence: 99%

“…There is an interaction between age and sex and it manifests as larger sex difference in younger than older patients. A large cohort study, showed that women with AMI arrived later at the emergency department, were less likely to be given aspirin therapy acutely, and had longer door-to-needle times (21) . Also on the day of discharge from the hospital, they were less likely to be prescribed beta-blockers.…”

Section: Discussionmentioning

confidence: 99%

Does Treatment Change with Gender in Acute Coronary Syndrome?

Daraghmeh¹,

Shah²,

Degheim³

et al. 2015

jcvd

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333Abstract Coronary artery disease (CAD) is the leading cause of death in women, with higher mortality and morbidity compared to men. We sought to evaluate whether an inequality in the primary medical treatment of acute myocardial infarction (AMI) exists in a sample population in a tertiary care hospital setting. There were no statistically significant differences in use of beta receptor blockers, aspirin, cholesterol lowering agent or cclopidogrel in both genders. However, women were slightly more likely to receive angiotensin converting enzyme inhibitor. There is an extensive literature suggesting gender bias in the management of patients with AMI, with women being treated less intensively than men. Our research highlights the fact that there were no statistically significant differences in the AMI medical management. Clinical management of men and women with AMI is similar and should follow the standard of care recommended by the related guidelines.

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Acute myocardial infarction in women: Contribution of treatment variables to adverse outcome

Cited by 94 publications

References 25 publications

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

Gender Differences in Hospital Mortality and Use of Percutaneous Coronary Intervention in Acute Myocardial Infarction

Does Treatment Change with Gender in Acute Coronary Syndrome?

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