Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women

Simon, Tabassome; Mary‐Krause, Murielle; Cambou, Jean-Pierre; Hanania, G; Guéret, Pascal; Lablanche, Jean‐Marc; Blanchard, Didier; Genès, N; Danchin, Nicolás

doi:10.1093/eurheartj/ehi719

Cited by 90 publications

(61 citation statements)

References 27 publications

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“…18 Both of these reports included overall AMI patients and did not examine STEMI patients in particular. 14,18 In our analysis, women who sustained very early deaths in our STEMI subpopulation were older, had slightly different risk profiles, and underwent revascularization and reperfusion less frequently than men. Whether the excess very early death among *ORs, which are for women vs men, were adjusted for age, race, BMI, insurance type, systolic blood pressure, cardiac diagnosis, initial ECG with diagnostic ST-segment elevation or left bundle-branch block, diabetes, hypertension, hyperlipidemia, heart failure, previous MI, peripheral vascular disease, renal insufficiency, stroke, chronic obstructive pulmonary disease, and adult history of smoking.…”

Section: Discussionmentioning

confidence: 89%

“…In 1 report paralleling our findings, the largest sex disparity in death rates after AMI occurred in the early hospitalization period, namely, during the initial 5 days of hospitalization. 14 Another study demonstrated increased case fatality after AMI in the initial 24 hours of hospitalization but did not find sex differences in case fatality during this time period. 18 Both of these reports included overall AMI patients and did not examine STEMI patients in particular.…”

Section: Discussionmentioning

confidence: 94%

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Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

et al. 2008

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 94%

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

et al. 2008

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“…Age was significantly associated with excess mortality even after adjusting for sex, comorbidities, and treatments. However, care must be taken in interpreting this result because it is possible that other unmeasured comorbidities were present in the older adults that may have biased the estimates 36, 37…”

Section: Discussionmentioning

confidence: 99%

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

149

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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“…In ongoing studies in recent decades gender-related issues in prognosis and treatment strategies were analyzed, but with no comment on CS [22][23][24][25]. Many studies have shown that poor clinical outcomes in women are related to suboptimal [26][27][28][29]. Conversely, several lines of evidence indicate that guidelines-compliant treatment in women and men results in significant improvements in outcomes [30].…”

Section: Bmi -Body Mass Index (Kg/m 2 ) MI -Myocardial Infarction Pmentioning

confidence: 99%

Mortality of women with ST-segment elevation myocardial infarction and cardiogenic shock – results from the PL-ACS registry

Kołodziej¹,

Kurzawski²,

Janion−Sadowska³

et al. 2016

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Słowa kluczowe: wstrząs kardiogenny, strategia rewaskularyzacji, optymalne leczenie, śmiertelność, różnice zależne od płci. AbstractIntroduction: Gender-related differences are well elucidated in ST-segment elevation myocardial infarction (STEMI) patients. However, data on patients with cardiogenic shock (CS) are scarce and do not indicate the cause-effect relationship. Aim of the research: To evaluate the differences between women and men with CS complicating STEMI and to identify factors which determine the prognosis in the female group. Material and methods: A total of 3589 consecutive patients with CS were selected from a large, multicenter national registry on 57 400 consecutive STEMI patients. Results: Women had a greater time delay from symptom onset to treatment (admission within the first 2 h, 37.1% vs. 44.8%; p < 0.001). They were also less likely to undergo interventional treatment (40.4% vs. 48.1%; p < 0.001) and to receive coronary stenting (86.8% vs. 90.1%; p = 0.045), glycoprotein IIb/IIIa inhibitors (15.3% vs. 20.1%; p < 0.001) and clopidogrel (46.3% vs. 53.6%; p < 0.001). In the female patients in-hospital and 12-month mortality were higher than in their male counterparts (55% vs. 45.8%; p < 0.001 and 72.5% vs. 63.8%; p < 0.001, respectively). Women with cardiogenic shock were less likely to receive optimal therapy than men, which resulted in a poor clinical outcome. Conclusions: This should encourage medical professionals to apply advanced therapeutic strategies without gender bias. Only if there are no gender-related discrepancies in the management of patients with cardiogenic shock may the beneficial impact of invasive treatment be fairly assessed and the hypothesis that more guideline-adherent treatment of women results in better outcomes be validated.

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Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women

Abstract: The higher 1-year mortality following AMI in women is explained by the higher risk of death in young women during the first days of hospitalization. Further investigations are crucial to determine the cause in order to improve the chance of survival in younger women.

Cited by 90 publications

References 27 publications

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

Sex Differences in Medical Care and Early Death After Acute Myocardial Infarction

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

Mortality of women with ST-segment elevation myocardial infarction and cardiogenic shock – results from the PL-ACS registry

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