Differences Between Men and Women in Terms of Clinical Features of ST-Segment Elevation Acute Myocardial Infarction

Abstract

any studies of sex-related differences in the shortand long-term outcomes of acute myocardial infarction (AMI) have concluded that mortality is higher among women than men. [1][2][3][4][5][6][7][8][9][10] The reason for poorer outcomes in women remains unclear. The higher mortality among women may be partially explained by the fact that women were older than men and had higher rates of unfavorable prognostic factors in previous studies. After the adjustment for these factors, however, several studies continued to show a survival disadvantage for women. 2,3,5,8 The persistence of higher mortality after risk adjustment may be because women usually receive less aggressive treatment for AMI than men. 2,3,8,11 However, analyses adjusting for baseline differences between women and men have yielded conflicting results. Several studies have found that sex is an independent risk factor for increased mortality after AMI, 1,4 whereas others have not. 6,7,12 Another potential explanation for the higher mortality among women is delayed presentation to the hospital. 13,14 In general, women with AMI present to the hospital later than men, suggesting different behavioral responses. Women have been reported to be less likely than men to believe that they are having a heart attack when they experience symptoms of AMI. 15 Several studies have reported that women have different or less typical symptoms of AMI than men. 14,16,17 Women are more likely to have non-chest pain, nausea or vomiting (or both), and shortness of breath. 14,17-20 These atypical symptoms may make it difficult for not only women with AMI, but also bystanders and health-care providers to correctly interpret the situation and take appropriate action. An important limitation of previous studies examining sexrelated differences in symptom presentation among patients with AMI was their retrospective design. Patients were interviewed by many different physicians, without the use of a standardized interview form. The results of interviews were thus subject to bias. More importantly, studies of sex-related differences in symptoms at the onset of AMI are lacking in Japan.To examine sex-related differences in the clinical features of ST-segment elevation AMI in Japan, we prospectively studied a series of men and women who were admitted to the coronary care unit of our Medical Center. In this pilot study, the same cardiologist interviewed all patients within 48 h after admission to minimize interview-related bias. Methods Study GroupFrom January 2001 through December 2004, 510 consecutive patients with ST-segment elevation AMI were admitted to our coronary care unit within 24 h after symp- Background Many studies have examined sex-related differences in the clinical features of acute myocardial infarction (AMI). However, prospective studies are scant, and sex-related differences in symptoms of AMI remain unclear. We examined differences between men and women in terms of the clinical features of ST-segment elevation AMI. Methods and ResultsWe studied 457 patients (106 wome...

Sex-Based Differences in Clinical Practice and Outcomes for Japanese Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…In the current study analyzing a recent AMI cohort treated by primary PCI, in-hospital mortality was higher among the women than the men, which is in accordance with a previous study showing higher in-hospital mortality despite lower peak creatinine phosphokinase levels in Japanese female patients with ST-elevation MI (STEMI). 26 Thus, in-hospital mortality was still higher among the women in a more recent cohort with more frequent use of cardioprotective agents and higher success rate of PCI. [26][27][28] Contrary to this, including the current study, a population-based study of 201,114 people in Scotland showed that the 30-day case fatality rate was lower in women than in men, when deaths from AMI that occur without hospital admission were taken into consideration.…”

“…26 Thus, in-hospital mortality was still higher among the women in a more recent cohort with more frequent use of cardioprotective agents and higher success rate of PCI. [26][27][28] Contrary to this, including the current study, a population-based study of 201,114 people in Scotland showed that the 30-day case fatality rate was lower in women than in men, when deaths from AMI that occur without hospital admission were taken into consideration. 10 Because the current study could not assess prehospital information, our results should be carefully interpreted.…”

Myocardial Infarction: Sex Differences in Symptoms Reported to Emergency Dispatch

“…and these conditions have been associated with MI without pain. 29,32,33 For patients who did not report chest pain, there were no sex differences in the symptoms reported, possibly due to insufficient statistical power due to small numbers. The most common non-chest pain symptoms for both men and women were shortness of breath, a fall, or collapse, syncope or unconsciousness.…”

Gender Differences in Delay Seeking Treatment and Related Experiences in Patients with Acute Myocardial Infarction

“…또한, AMI의 발생 시 환자가 호소하는 증상 가운데 비전형적인 증상이 남성보다 여성에서 훨씬 많다고 보고되었 다 [11]. 즉, 남성은 AMI의 임상증상으로 흉통이나 발한을 보 고하는 반면, 여성은 등, 턱, 목에 오는 통증, 구역과 구토, 호흡 곤란, 피로, 식욕부진 등을 더 경험한다고 하였다 [11,12] …”