SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization

Lansky, Alexandra J.; Baron, Suzanne J.; Grines, Cindy L.; Tremmel, Jennifer A.; Al‐Lamee, Rasha; Angiolillo, Dominick J.; Chieffo, Alaide; Croce, Kevin; Jacobs, Alice K.; Madan, Mina; Maehara, Akiko; Mehilli, Julinda; Mehran, Roxana; Ng, Vivan; Parikh, Puja B.; Saw, Jacqueline; Abbott, J. Dawn

doi:10.1016/j.jscai.2021.100016

Cited by 5 publications

(14 citation statements)

References 179 publications

(200 reference statements)

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“…Large dataset analyses have consistently and persistently demonstrated less favorable outcomes in women with acute MI as compared to men, particularly those with STEMI, and especially those under the age of 60 years (1)(2)(3)(4)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

“…3 Analysis was based on available data in PCI-PRAGUE 1,2 (N = 125) and PRAGUE 18 (N = 254). 4 Analysis was based on available data in PRAGUE 2 (N = 101) and PRAGUE 18 (N = 217).…”

Section: Methodsmentioning

confidence: 99%

“…Women with acute myocardial infarction (MI) have a worse prognosis than men (1)(2)(3)(4). This is partly due to the older age of women and age-associated comorbidities.…”

Section: Introductionmentioning

confidence: 99%

“…The approach to the treatment of STEMI has undergone a marked transformation regarding preference for mechanical reperfusion, percutaneous coronary intervention (PCI) network organization that shortens the time to reperfusion, intensification of antithrombotic treatment in the acute phase, and its dynamic adjustment to ischemia and bleeding risks over the long-term. Since women are a special subgroup representing 23 -40% (12) of STEMI patients, it is important to determine whether directions of Abbreviations: STEMI, ST-elevation myocardial infarction; PCI, percutaneous coronary intervention; OR, odds ratio; CI, confidence interval; SD, standard deviation; TIMI, Thrombolysis in Myocardial Infarction.…”

Section: Introductionmentioning

confidence: 99%

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Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials

Moťovská

Hlinomaz²,

Aschermann³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSex- and gender-associated differences determine the disease response to treatment.AimThe study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women.Methods and resultsWe performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03–3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0–2.23]), and also for an optimal procedural result (4.24 [2.12–8.49], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17–0.91], p = 0.029).ConclusionThe prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.

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Section: Discussionmentioning

confidence: 99%

“…3 Analysis was based on available data in PCI-PRAGUE 1,2 (N = 125) and PRAGUE 18 (N = 254). 4 Analysis was based on available data in PRAGUE 2 (N = 101) and PRAGUE 18 (N = 217).…”

Section: Methodsmentioning

confidence: 99%

“…Women with acute myocardial infarction (MI) have a worse prognosis than men (1)(2)(3)(4). This is partly due to the older age of women and age-associated comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trends in outcomes of women with myocardial infarction undergoing primary angioplasty—Analysis of randomized trials

Moťovská

Hlinomaz²,

Aschermann³

et al. 2023

Front. Cardiovasc. Med.

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“…35 Delays can be due to a lack of patient or physician recognition and/or physician biases given the known lower likelihood of obstructive coronary artery disease (CAD) or higher procedural complications in women. 36 Moreover, studies have shown that depression, caregiving demands and poorer SEP all influence the use of recommended medical care by women. 37,38 Black patients in the US, especially black women, undergo fewer cardiovascular procedures and potential reasons include long-term consequences of systemic racism such as lack of trust in the healthcare system, provider biases and low SEP. 4 Although lack of insurance plays a role in disparities of care, providing insurance coverage did little to reduce disparities in coronary revascularisation in a study based in Massachusetts.…”

Section: Socioeconomic Disparities In Usage and Resource Access In Co...mentioning

confidence: 99%

Socioeconomic Factors and their Impact on Access and Use of Coronary and Structural Interventions

et al. 2022

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In the past few decades, the accelerated improvement in technology has allowed the development of new and effective coronary and structural heart disease interventions. There has been inequitable patient access to these advanced therapies and significant disparities have affected patients from low socioeconomic positions. In the US, these disparities mostly affect women, black and hispanic communities who are overrepresented in low socioeconomic. Other adverse social determinants of health influenced by structural racism have also contributed to these disparities. In this article, we review the literature on disparities in access and use of coronary and structural interventions; delineate the possible reasons underlying these disparities; and highlight potential solutions at the government, healthcare system, community and individual levels.

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