Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry)

Heer, Tobias; Schiele, Rudolf; Schneider, Steffen; Gitt, Anselm K.; Wienbergen, Harm; Gottwik, Martin; Gieseler, Ulf; Voigtländer, Thomas; Hauptmann, Karl E.; Wagner, Ştefan; Senges, Jochen

doi:10.1016/s0002-9149(01)02289-5

Cited by 185 publications

(171 citation statements)

References 28 publications

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“…However in this study, the strongest predictors of not receiving reperfusion therapy were advanced age, delayed presentation, high systolic blood pressure and geographic region (South Africa). Previous studies have shown that women are less likely to be considered for reperfusion therapy than men, in some cases even after adjusting for important clinical differences [17][18][19]. Despite the higher mortality rates in women, fewer women may receive major diagnostic and therapeutic procedures than men [20][21][22], even though women treated with early aggressive revascularization procedures may have a better long-term outcome than that of men [23].…”

Section: Discussionmentioning

confidence: 99%

“…The underutilization of thrombolytic therapy in women may be partly a result of a longer time from symptom onset to hospital arrival compared with men [5,18,19,24]. Possible reasons for the longer delay may be the age at which women experience a first myocardial infarction, concomitant chronic diseases, atypical presentation of cardiac symptoms, and a reduced perception of risk of myocardial infarction by women themselves and healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

Cohen

Gensini

Maritz

et al. 2005

J Thromb Thrombolysis

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Abstract. Background: The standard of care for STsegment elevation myocardial infarction (STEMI) is prompt coronary reperfusion with thrombolysis or percutaneous coronary intervention. Women have higher mortality rates than men following STEMI and fewer women are considered eligible for reperfusion therapy. We analyzed the impact of gender, and other factors, on the outcome and treatment of STEMI in the TETAMI trial and registry.Methods: This exploratory analysis included 2741 patients from Treatment with Enoxaparin and Tirofiban in Acute Myocardial Infarction (TETAMI) presenting with STEMI within 24 hours of symptom onset. The primary composite end point was the combined incidence of all-cause death, recurrent myocardial infarction, and recurrent angina, at 30 days. Three multivariate analyses were performed to determine predictors of not receiving reperfusion therapy, the composite end point, or death.Results: The triple end point occurred in 17.8% of women versus 13.3% of men. Reperfusion therapy was utilized in 38.2% of women versus 47.3% in men. However, age >75 years, delayed presentation, high systolic blood pressure (>100) and region (South Africa), were significant, independent predictors of not receiving reperfusion therapy. Significant predictors of the triple end point included not receiving reperfusion therapy, age >60 years, and higher Killip class. Predictors of death included age >60 years, low systolic blood pressure, higher Killip class, high heart rate, delayed presentation, and region (South Africa and South America).Conclusion: Female gender was not an independent predictor of outcome or underutilization of reperfusion therapy. Factors more common in female STEMI patients (advanced age and delayed presentation) were associated with not receiving reperfusion therapy and adverse outcome. Increased awareness is needed to reduce delayed presentation after symptom onset, especially among women.Abbreviated abstract. In this analysis of 2741 STsegment elevation myocardial infarction patients in the TETAMI trial and registry, a trend was observed for women being less likely to receive reperfusion therapy and more likely to have an adverse outcome than men. This was related to factors more common in female patients (advanced age and delayed presentation), and showed that an increased awareness is needed to reduce delayed presentation after symptom onset, especially among women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

Cohen

Gensini

Maritz

et al. 2005

J Thromb Thrombolysis

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“…Comparison of use ofâ-blockers showed it was underused in females (63%) compared to males (75%) which is statistically significant (p=0.046).This finding is consistent with previous reports. 9,10,[12][13][14][15] The significant underuse of â-blockers in female patients in our study may be explained by the fact that more females had diabetes mellitus and congestive heart failure. International data support the fact that despite recommendations in favour of use of â-blockers, these are still underused in post-infarct patients, at the expense of many lives lost 17 .…”

Section: Discussionmentioning

confidence: 69%

“…Streptokinase was significantly underused in females (15.6%) compared to males (32.2%) (p=0.011).Underuse of reperfusion therapy was also reported in other studies. 7,10,13 The underuse of reperfusion therapy in our female patients may be explained by higher frequency of prehospital delay (>12 hours) in females (72%) compared to their male counterpart (58%) (p=0.038). Nag et al 16 also explained delayed arrival as a cause of underuse of Streptokinase.…”

Section: Discussionmentioning

confidence: 90%

“…The difference is significant (p=0.032).Similar results were observed by Hossain et al 3 and others. 7,10 Several other studies 11,13,14 conducted around different parts of the world also reported higher in-hospital mortality in females than in males.Analysisof complications showed that in our series, Killip class III or more of cardiac failure was found in 14% females and 7% males. Our findings are in accordance with those found byjiang et al 10 andVaccarinoet al 14 .…”

Section: Discussionmentioning

confidence: 92%

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Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

et al. 2018

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Abstract:Background: In-hospital mortality in female patients with acute myocardial infarction (AMI) and factors affecting this may be different from those of their male counterpart. The aim of the current study was to compare the in-hospital mortality between female and male patients with AMI and to compare the differences in age, risk factors, treatment given and complications between them. Methods: Total 200 nonrandomised patients with a definite diagnosis of AMI admittedover a period of one year (January 2008 -December 2008) were enrolled in the study, in which 100 female patients were considered as cases and 100 male patients as controls. Both groups were studied prospectively.Datawere collected in prefixed questionnaire and data sheet and were analysed using SPSS software.Results: mean age of the female patients was significantly higher than that of their male counterpart (57.0±10.1 years and 53.3±10.3 years respectively, p=0.029). Diabetes mellitus and hyperlipidemia were significantly higher in females than those in males (39% vs 24%, p=0.022 and 45% vs 32%, p=0.040 respectively), while smoking was staggeringly higher among the males (59%) compared to the females (4%) (p<0.001).However, no significant difference was observed between the groups in terms of hypertension (p=0.666).Pre-hospital delay (more than 12 hours after onset of chest pain) was significantly higher in the female group than that in the male group (72% vs 58%,p=0.038). Streptokinase was significantly underused in females (15.6%) compared to that used in males (32.2%) (p=0.011). The use of b-receptor blockerswas also significantly less in females than that in males (63% vs 75%, p=0.046).Death was significantly higher in the females (21%) than that in the males (10%) (p=0.032). Unstable angina, re-infarction and congestive heart failure were somewhat higher in the female subjects compared to their male counterparts (40% vs 34%, 2% vs 1% and 32% vs 23% respectively) though the differences did not seem significant (p=0.380, p=0.561 and p=0.154 respectively). Arrhythmias did not differ significantly between the groups (p 1 >0.05).Conclusion: Female patients with AMI had significantly higher in-hospital mortality. Early hospitalization and optimal treatment are crucial to decrease mortality in female patients.

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Women and Heart Disease

Barrett‐Connor¹,

Giardina²,

Gitt³

et al. 2004

Arch Intern Med

136

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Cardiovascular disease (CVD) is the primary cause of death in women, and women with type 2 diabetes mellitus are at greater risk of CVD compared with nondiabetic women. The increment in risk attributable to diabetes is greater in women than in men. The extent to which hyperglycemia contributes to heart disease risk has been examined in observational studies and clinical trials, although most included only men or did not analyze sex differences. The probable adverse influence of hyperglycemia is potentially mediated by impaired endothelial function, and/or by other mechanisms. Beyond high blood glucose level, a number of other common risk factors for CVD, including hypertension, dyslipidemia, and cigarette smoking, are seen in women with diabetes and require special attention. Presentation and diagnosis of CVD may differ between women and men, regardless of the presence of diabetes. Recognizing the potential for atypical presentation of CVD in women and the limitations of common diagnostic tools are important in preventing unnecessary delay in initiating proper treatment. Based on what we know today, treatment of CVD should be at least as aggressive in women-and especially in those with diabetes-as it is in men. Future trials should generate specific data on CVD in women, either by design of female-only studies or by subgroup analysis by sex.

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Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry)

Cited by 185 publications

References 28 publications

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

The Role of Gender and Other Factors as Predictors of Not Receiving Reperfusion Therapy and of Outcome in ST-Segment Elevation Myocardial Infarction

Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

Women and Heart Disease

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