Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Abstract

BACKGROUNDCoronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients.OBJECTIVESTo identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients.DESIGNRetrospective analysis.SETTINGSHospitals across Malaysia.PATIENTS AND METHODSWe analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender.MAIN OUTCOME MEASURESDifferential risk factors for each gender.RESULTSFor the 19 484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P<.001). The univariate analysis showed that the majority of male patients <65 years while females were ≥65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group.CONCLUSIONGender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI.LIMITATIONRetrospective registry data with inter-hospital variation.

Clinical characteristics and outcomes of ST-segment elevation myocardial infarction in a low income setting in rural Bangladesh

“…Understanding social barriers for female patients to seek emergent medical treatment after STEMI in a low income setting would be crucial in regard to improving clinical outcomes of female patients. Sex was not independently associated with increased in-hospital mortality in our study (Table 3), presumably due to small sample size and other confounding variables, while one study showed that the mortality rate of female patients after STEMI was two times higher than male counterparts [18]. More clinical and socioeconomic differences in female patients with STEMI should be scrutinized particularly in a low income setting in Bangladesh.…”

“…It is known that women are more prone to presenting with atypical symptoms (fatigue, dyspnea, nausea, and abdominal complaints) during STEMI and more likely to have the delay in seeking medical care. Moreover, several studies showed that there were differences in terms of clinical presentation, applying evidence-based therapies and clinical outcomes according to gender [[16], [17], [18]]. Understanding social barriers for female patients to seek emergent medical treatment after STEMI in a low income setting would be crucial in regard to improving clinical outcomes of female patients.…”

Management of Coronary Artery Disease: Differences in Sex

“…Sigara kullanan bireylerde KAH başta olmak üzere bir çok kronik hastalık görülmektedir. Literatürde sigara kullanımı erkeklerde daha fazla olduğu bilinmekle birlikte [4,20] , özellikle son yıllarda sigara kullanımında kadın ve erkekler arasında fark olmadığını gösteren çalışma sonuçları da bulunmaktadır. [21,22] Bu araştırmada erkeklerde sigara kullanımı istatistiksel olarak yüksek bulundu.…”

Gender-Based Differences in Clinical Profile and Outcome of Primary Percutaneous Coronary Intervention in Patients With St-Segment Elevation Myocardial Infarction

“…Various studies have found female gender to be associated with a significant increased risk of shortand long-term mortality after acute coronary event. [4][5][6][7][8][9][10][11][12][13] Nonetheless, there exist a conflict of evidence as ample literature also available suggesting either no gender differences in outcomes or attributing differences in outcomes with differences in baseline characteristics or increased burden of comorbidities in women due to relatively older age at presentation. 14,15 Studies reporting gender disparities in outcomes postulated various determinants of higher rate of adverse events in women, some studies argued that the atypical clinical presentation is more common among women also pre-hospital delay is more common for females as compared to their male counterpart resulting in delay in reperfusion therapy.…”