Observed and Expected Survival in Men and Women after Suffering a STEMI

Pascual, Isaac; Hernández-Vaquero, Daniel; Almendárez, Marcel; Lorca, Rebeca; Escalera, Alain; Díaz, Rocío; Alperi, Alberto; Carnero, Manuel; Silva, Jacobo; Morı́s, César; Avanzas, Pablo

doi:10.3390/jcm9041174

Cited by 19 publications

(10 citation statements)

References 31 publications

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“…However, one-year and long-term mortality is controversial. Pascual reported that gender difference is not a risk factor for one-year mortality in STEMI patients [ 46 ], which was supported by the present study results. However, other reports have revealed higher one-year mortality in women compared to men, which is explained by the worse clinical profile and the reduced rate of reperfusion therapy [ 47 – 49 ].…”

Section: Discussionmentioning

confidence: 99%

ST-segment elevation myocardial infarction in North African women: results from a twenty-year experience.

Chamtouri¹,

Souissi²,

Amdouni³

et al. 2022

Journal of the Saudi Heart Association

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Background Coronary artery disease remains the most common cause of morbidity and mortality in the general population. Several studies in developed countries have reported a gender-related difference in ST-segment elevation myocardial infarction (STEMI) in terms of risk factors, clinical presentation, delays in management, therapeutic modalities, and in-hospital as well as one-year outcomes. Data from non-developed countries about women with STEMI remain rare. We therefore aimed through this study to investigate the baseline characteristics of STEMI in Tunisian women compared to men and to determine the impact of gender difference on STEMI complications, in-hospital mortality, and one-year follow-up outcomes. Methods All patients presenting to our center for STEMI between January 2001 and January 2021 were retrospectively enrolled in this analysis. Clinical features, therapeutic management, and in-hospital as well as one-year outcomes were compared between women and men. Predictive factors of in-hospital mortality in women were determined. Results Out of 1670 STEMI hospitalizations, 359 (21.4%) were female. Compared to male, female had higher rates of hypertension (51.5% vs. 24.4%, p < 0.001), diabetes (50.1% vs. 32.2%, p < 0.001), and obesity (63.8% vs. 55%, p = 0.003). The clinical presentation was characterized by less prevalent inaugural chest pain (58.8% vs. 68.6%, p < 0.001). Atypical symptoms were significantly higher in women compared to men (55.2% vs. 5%, p<0.001). On admission, women had higher prevalence of anemia, renal failure, and hyperglycemia compared to men. Primary percutaneous coronary intervention (pPCI) was the reperfusion strategy of choice in 37.9% of women vs. 33.1% of men (p=0.02). Women were significantly less likely to receive thrombolysis (p = 0.004), with a significantly less prevalent successful thrombolysis (55.6% vs. 67.2%, p=0.013). In-hospital mortality was markedly higher in women compared to men (12.8% vs. 7.3%, p=0.001). Compared to surviving women (n = 313), those who died (n = 46) frequently had more diabetes and hypertension (65.2% vs. 47.9%, p= 0.02 and 67.4% vs. 49.2%, p = 0.02, respectively). New-onset atrial fibrillation, acute left heart failure, cardiogenic shock, ventricular tachycardia, and atrioventricular block markedly occurred in women who died (52.2% vs. 23.3%, p=<0.001; 17.4% vs. 1.9%, p < 0.001; 19.6% vs. 8.3%, p = 0.016; 15.2% vs. 1.6%, p < 0.001 and 34.8% vs. 10.2%, p < 0.001, respectively). Conclusion Compared to men, Tunisian women presenting for STEMI had higher prevalence of risk factors and atypical symptoms. Women had more in-hospital complications and mortality.

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Section: Discussionmentioning

confidence: 99%

ST-segment elevation myocardial infarction in North African women: results from a twenty-year experience.

Chamtouri¹,

Souissi²,

Amdouni³

et al. 2022

Journal of the Saudi Heart Association

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show abstract

“…Women with ACS in comparison to men had been at a higher risk for poor clinical outcomes following PCI, particularly in the short-term follow-up period after primary PCI [18,19]. However, the exact mechanisms of these sex-specific differences remain unclear and are probably multifactorial [20].…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Clinical Features and Outcomes of Patients with Acute Coronary Syndrome Treated with Two Generations (Absorb and Magmaris) of Bioresorbable Vascular Scaffolds

Włodarczak¹,

Rola

Szudrowicz³

et al. 2021

JCM

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Background: Despite the developments in percutaneous coronary interventions (PCI), women are still more likely than men to have unfavorable outcomes after PCI performed in Acute Coronary Syndrome (ACS). The mechanisms of this phenomena are not fully understood. Potential benefits of bioresorbable scaffolds (BRS) may be particularly expressed in the female population. Nevertheless, the data available currently are inconsistent and limited. This study evaluated the gender-related differences in the short-term clinical outcomes in ACS patients treated with implantation of two generations of BRS (first generation, Absorb; second generation, Magmaris). Methods: The study was divided into two arms. To the first one, we qualified 160 patients with ACS treated with PCI who received 210 Absorb scaffolds. The second arm was composed of 193 patients with ACS who underwent PCI with Magmaris implantation. Results: There were no significant sex-related differences in primary endpoints (cardiovascular-death, myocardial infarction, in-stent thrombosis) or principal secondary endpoints (of target-lesion failure, scaffold restenosis, death from any reason, other cardiovascular events) in either generation of BRS in a 1-year follow-up. Conclusions: Both genders tended to have a similar outcome in routine clinical practice following BRS implantation due to ACS. The magnesium bioresorbable scaffold (Magmaris) early outcome seemed to be more favorable in comparison to the Absorb scaffold.

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“…The statistical process comparing the survival rate of patients experiencing premature STEMI with that of the general population of the same sex, age, and region was calculated as reported elsewhere [ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

Lorca

Pascual

Aparicio

et al. 2021

JCM

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Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

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Observed and Expected Survival in Men and Women after Suffering a STEMI

Cited by 19 publications

References 31 publications

ST-segment elevation myocardial infarction in North African women: results from a twenty-year experience.

ST-segment elevation myocardial infarction in North African women: results from a twenty-year experience.

Sex Differences in the Clinical Features and Outcomes of Patients with Acute Coronary Syndrome Treated with Two Generations (Absorb and Magmaris) of Bioresorbable Vascular Scaffolds

Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

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