Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive Coronary Artery Disease

Johnston, Nina; Jönelid, Birgitta; Christersson, Christina; Kero, Tanja; Renlund, Henrik; Schenck‐Gustafsson, Karin; Lagerqvist, Bo

doi:10.1016/j.amjcard.2015.03.006

Cited by 53 publications

(39 citation statements)

References 16 publications

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“…These findings agree with most earlier studies4, 5, 6, 7, 8, 9, 10, 11, 12, 26 in which standard survival analyses were applied. Using the relative survival approach, we found that women with STEMI and NSTEMI had higher excess mortality rates compared with their male counterparts.…”

Section: Discussionsupporting

confidence: 92%

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Alabas

Gale

Hall

et al. 2017

JAHA

148

122

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BackgroundThis study assessed sex differences in treatments, all‐cause mortality, relative survival, and excess mortality following acute myocardial infarction.Methods and ResultsA population‐based cohort of all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART [Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies]) from 2003 to 2013 was included in the analysis. Excess mortality rate ratios (EMRRs), adjusted for clinical characteristics and guideline‐indicated treatments after matching by age, sex, and year to background mortality data, were estimated. Although there were no sex differences in all‐cause mortality adjusted for age, year of hospitalization, and comorbidities for ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI at 1 year (mortality rate ratio: 1.01 [95% confidence interval (CI), 0.96–1.05] and 0.97 [95% CI, 0.95–0.99], respectively) and 5 years (mortality rate ratio: 1.03 [95% CI, 0.99–1.07] and 0.97 [95% CI, 0.95–0.99], respectively), excess mortality was higher among women compared with men for STEMI and non‐STEMI at 1 year (EMRR: 1.89 [95% CI, 1.66–2.16] and 1.20 [95% CI, 1.16–1.24], respectively) and 5 years (EMRR: 1.60 [95% CI, 1.48–1.72] and 1.26 [95% CI, 1.21–1.32], respectively). After further adjustment for the use of guideline‐indicated treatments, excess mortality among women with non‐STEMI was not significant at 1 year (EMRR: 1.01 [95% CI, 0.97–1.04]) and slightly higher at 5 years (EMRR: 1.07 [95% CI, 1.02–1.12]). For STEMI, adjustment for treatments attenuated the excess mortality for women at 1 year (EMRR: 1.43 [95% CI, 1.26–1.62]) and 5 years (EMRR: 1.31 [95% CI, 1.19–1.43]).ConclusionsWomen with acute myocardial infarction did not have statistically different all‐cause mortality, but had higher excess mortality compared with men that was attenuated after adjustment for the use of guideline‐indicated treatments. This suggests that improved adherence to guideline recommendations for the treatment of acute myocardial infarction may reduce premature cardiovascular death among women.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02952417.

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Section: Discussionsupporting

confidence: 92%

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Alabas

Gale

Hall

et al. 2017

JAHA

148

122

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“…The effect of sex on incidence of acute MI without obstructive CAD was assessed among 95,849 patients undergoing angiography in the Swedish Coronary Angiography and Angioplasty Registry (72). Analyses in 2,268 STEMI and 10,904 non-ST-segment elevation myocardial infarction (NSTEMI) patients without obstructive CAD (<50% stenosis) revealed the presence of nonobstructive CAD in 7% of STEMI (6% men, 10% women) and 17% of NSTEMI patients (11% men, 28% women).…”

Section: Syndromes Associated With Nonobstructive Cad and Adverse Outmentioning

confidence: 99%

Emergence of Nonobstructive Coronary Artery Disease

Pepine

Ferdinand

Shaw

et al. 2015

Journal of the American College of Cardiology

256

117

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Recognition of ischemic heart disease (IHD) is often delayed or deferred in women. Thus, many at risk for adverse outcomes are not provided specific diagnostic, preventive, and/or treatment strategies. This lack of recognition is related to sex-specific IHD pathophysiology that differs from traditional models using data from men with flow-limiting coronary artery disease (CAD) obstructions. Symptomatic women are less likely to have obstructive CAD than men with similar symptoms, and tend to have coronary microvascular dysfunction, plaque erosion, and thrombus formation. Emerging data document that more extensive, nonobstructive CAD involvement, hypertension, and diabetes are associated with major adverse events similar to those with obstructive CAD. A central emerging paradigm is the concept of nonobstructive CAD as a cause of IHD and related adverse outcomes among women. This position paper summarizes currently available knowledge and gaps in that knowledge, and recommends management options that could be useful until additional evidence emerges.

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“…Therefore, we suggest that even changes of the coronary arteries not classified as lesion for myocardial revascularization (B50 %) are potentially able to fuel future cardiovascular events in view of cardiovascular events [2,6,[24][25][26]. Importantly, the Gensini score was predictive to identify patients with future events even after including all cardiovascular risk factors and renal function in a cohort with nonobstructive lesions.…”

Section: Extent Of Coronary Artery Disease and Future Eventsmentioning

confidence: 86%

“…A predominant aspect of the NOB-CAD cohort is the higher number of women as this might characterize a gender-related aspect of CAD [2,24,34]. Further, NOB-CAD presented more often with stable CAD compared to acute coronary syndrome.…”

Section: Clinical Presentation Of Nonobstructive Cadmentioning

confidence: 93%

SYNTAX score-0 patients: risk stratification in nonobstructive coronary artery disease

Sinning¹,

Zengin

Waldeyer

et al. 2016

Clin Res Cardiol

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Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive Coronary Artery Disease

Cited by 53 publications

References 16 publications

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry

Emergence of Nonobstructive Coronary Artery Disease

SYNTAX score-0 patients: risk stratification in nonobstructive coronary artery disease

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