Gender differences in acute myocardial infarction—A nationwide German real‐life analysis from 2014 to 2017

Kuehnemund, L; Köppe, Jeanette; Feld, Jannik; Wiederhold, A; Illner, J; Makowski, Lena; Gerß, Joachim; Reinecke, Holger; Freisinger, Eva

doi:10.1002/clc.23662

“…On the other hand, several studies in the literature reported a higher mortality rate for female STEMI patients with a less invasive approach, above all in specific socio-economic and cultural areas [7,8]. A German national study showed a 7% increase in in-hospital mortality in STEMI female patients independently from the presence of the main cardiovascular risk factors at baseline [33]. Similar results were reported in a subanalysis of the large SWEDEHEART registry with a higher short-term mortality among female STEMI patients strongly related to age [34].…”

Section: Discussionmentioning

confidence: 99%

293 Impact of Female Gender on Acute and Mid-Term Mortality in Patients With St-Segment Elevation Myocardial Infarction During the Pandemic Era

Barbieri

¹

,

Avallone

²

,

́errico

³

et al. 2022

European Heart Journal Supplements

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Background There is still much controversy concerning the impact of gender on mortality during ST-segment elevation myocardial infarction (STEMI). The COVID-19 pandemic deeply affected the clinical history of these patients, both in terms of presentation time and management. The aim of our study was to evaluate the impact of female gender on acute and mid-term mortality in STEMI patients hospitalized during the pandemic period. Materials and Methods Our study focuses on STEMI patients hospitalized during the darkest period of the pandemic. We retrospectively analyzed consecutive STEMI patients hospitalized from 15 March 2020 to 15 March 2021 in our Hub centre in Milan, Lombardy. All clinical, demographic, and procedural characteristics were collected in a dedicated database. Patient follow-up was carried out through clinical visits, telephone calls and remote monitoring through the “Lombardia Regional Registry”. Results From a total of 283 patients, women represented 26.8% of the population, with a mean age of 72 - 11.2 years vs. 64.7 - 12.6 years in men. Anterior STEMI was the most represented with a mildly reduced ejection fraction (EF 48.3 _ 11.8%) similar between genders. Coronary angiography showed more extensive disease in man, while women presented with a higher Killip class at admission and a more pronounced anemic status. In-hospital and 1-year mortality of the whole cohort were 11.4% and 7.5%, respectively, with no significant differences between genders (14.5% women vs. 10.6% men, p = ns; 9.2% women vs. 7% man, p = ns). EF resulted in being the only independent predictor of mortality in the short-term and at 1-year follow up in both genders. In the acute phase, the only other independent predictor of mortality was COVID-19 infection, secondary to the higher rate of respiratory omplications, without any difference in terms of major adverse cardiac events. The impact of COVID-19 infection on mortality was completely lost at 1-year follow up. Conclusions Our study has shown that female gender in STEMI patients does not represent an independent predictor of mortality both in the short- and in the mid-term follow up. Concomitant COVID-19 infection significantly influenced in-hospital mortality due to the higher rate of respiratory complications in both genders. The impact of COVID-19 on mortality was completely lost at follow-up, where age and a reduced EF remained the only independent predictors, regardless of gender.

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“…Prior studies showed female STEMI patients had higher in-hospital and external mortality, even among young patients, women with ACS had higher in-hospital mortality than their counterparts [ 7 , 21 – 24 ]. Consistent with prior investigations, the sex differences among STEMI patients in the in-hospital outcomes were significant in our study, the rates of in-hospital clinical outcomes for women were nearly doubled, and what's more, the rates of adjusted in-hospital clinical outcomes were still higher in women.…”

Section: Discussionmentioning

confidence: 99%

Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry

Wang

¹

,

Zhang

²

,

Cheng

³

et al. 2022

Cardiology Research and Practice

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Background. Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences. Method. We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016–2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates. Results. Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%, P < 0.001 ) and diabetes (24.5% vs. 15.2%, P < 0.001 ). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%, P < 0.001 ); the onset to first medical contact (FMC) (255 vs. 190 minutes, P < 0.001 ), onset to fibrinolysis (218 vs. 185 minutes, P < 0.001 ), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes, P < 0.001 ) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%, P < 0.001 ), death or treatment withdrawal (14.5% vs. 5.6%, P < 0.001 ), and MACCE (18.5% vs. 9.4%, P < 0.001 ) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12–2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26–2.24), and MACCE (OR: 1.37, 95% CI: 1.08–1.74) after adjustment for covariates. Among possible explanatory factors, age (−58.46%, −59.04%, −62.20%) and cardiovascular risk factors (−40.77%, −39.36%, −41.73%) accounted for most of the gender-associated risk differences. Conclusions. Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.

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“…This may reflect doctors’ attempt not to add another drug to patients who are already poly-treated, as elderly patients often are, and the exacerbation of this attitude during the pandemic may explain the sharp reduction in prescribing rate the over-80s, as well as the higher rate of treatment in younger individuals, where concomitant therapies are less likely. Regarding women, several studies have pointed out a sex-related gap in the treatment for AMI, that encompass timeliness in medical care, pharmacological treatments, and surgical procedures ( Liakos and Parikh, 2018 ; Hao et al, 2019 ; Kuehnemund et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy’s first wave of the COVID-19 pandemic

Olmastroni

¹

,

Galimberti

²

,

Catapano

³

et al. 2022

Front. Pharmacol.

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Background: Major guidelines recommend the initiation of a beta-blocker therapy after an acute myocardial infarction (AMI). We aimed to map the treatment pathway of beta-blockers for AMI survivors during the first wave of COVID-19 pandemic in Italy and to investigate predictors for treatment non-initiation.Methods: Healthcare utilization databases of Lombardy Region were investigated. Subjects aged ≥18 years who were hospitalised with AMI in the period February-March-April of 2018, 2019, and 2020 were included, and followed for 30 days from the discharge date, to investigate whether they presented a first prescription of beta-blockers. A multivariate logistic model was performed to evaluate the effect of several covariates on the probability of not receiving a post-AMI beta-blocker therapy.Results: The cohorts comprised 2259, 2383, and 1932 individuals who were hospitalised with AMI in the 3-month period in 2018, 2019, and 2020, respectively. Overall in 2020, about 58–60% of individuals with AMI received a prescription of beta-blockers within 1 month after the discharge. A continuous decreasing trend over time was observed. Men were 30% more likely to start the treatment than women, increasing age was associated with significant increasing probability of not receiving a post-infarction beta-blocker therapy, while having received an antihypertensive or lipid-lowering treatment, or having been hospitalized for heart failure prior to the AMI hospitalization reduced the likelihood of not being treated with beta-blockers.Conclusion: The initiation of beta-blocker treatment after AMI remains an under-prescribed practice, that does not seem to have been further affected by the first wave of the COVID-19 pandemic.

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Gender differences in acute myocardial infarction—A nationwide German real‐life analysis from 2014 to 2017

Cited by 35 publications

References 39 publications

293 Impact of Female Gender on Acute and Mid-Term Mortality in Patients With St-Segment Elevation Myocardial Infarction During the Pandemic Era

293 Impact of Female Gender on Acute and Mid-Term Mortality in Patients With St-Segment Elevation Myocardial Infarction During the Pandemic Era

Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry

Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy’s first wave of the COVID-19 pandemic

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