Sex, Myocardial Infarction, and the Failure of Risk Scores in Women

Agrawal, Shashank; Eyk, Jennifer E. Van; Wei, Janet; Merz, C. Noel Bairey

doi:10.1089/jwh.2015.5412

Cited by 27 publications

(15 citation statements)

References 27 publications

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“…In our study, troponin T levels were similar in both sexes. While women have smaller left ventricular mass similar troponin T levels may suggest greater myocardial damage compared to men, as supported by recent data [14]. These facts could explain our finding that women with higher troponin T levels had markedly higher incidence of hypotension episodes, although we observed only non-significantly increased troponin T levels adjusted for BSA in women.…”

Section: Discussionsupporting

confidence: 88%

Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates

et al. 2017

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ObjectiveThe introduction of primary percutaneous coronary intervention (PPCI) has modified the profile of ST elevation myocardial infarction (STEMI) patients. Occurrence and prognostic significance of hypotension episodes are not known in PPCI treated STEMI patients. It is also not known whether and/or how the hypotension episodes correlate with the degree of myocardial damage and whether there are any sex differences.MethodsData of 293 consecutive STEMI patients (189 males) treated by PPCI and without cardiogenic shock were analyzed. Blood pressure was measured noninvasively. A hypotensive episode was defined as a systolic blood pressure below 90 mmHg over a period of at least 30 minutes.ResultsA hypotensive episode was observed in 92 patients (31.4%). Female sex was the strongest independent predictor of hypotension episodes (p < 0.0001), while there was no relationship to electrocardiographic STEMI localization. Hypotensive patients had significantly higher levels of troponin T and brain natriuretic peptide; hypotensive episodes were particularly frequent in women with increased troponin T. Treatment with angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB) and betablockers was less frequent in hypotensive patients. After a mean 20-month follow-up, all-cause mortality did not differ between hypotensive patients and others. However, mortality in hypotensive patients who did not tolerate ACEI/ARB therapy was significantly higher compared to other hypotensive patients (p = 0.016).ConclusionHypotension episodes are not uncommon in the sub-acute phase of contemporarily treated STEMI patients with a striking difference between sexes—female sex was the strongest independent predictor of hypotension episodes. Hypotensive episodes may lead to a delay in pharmacotherapy which influences prognosis. Higher incidence of hypotension in women could at least partially explain the sex-related differences in the use of cardiovascular pharmacotherapy which was repeatedly observed in various studies.

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Section: Discussionsupporting

confidence: 88%

Higher incidence of hypotension episodes in women during the sub-acute phase of ST elevation myocardial infarction and relationship to covariates

et al. 2017

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“…141 Additionally, current risk scores, based on ACS thresholds determined in predominantly male-based populations, do not accurately predict risk in women, showing the need for sex-specific biomarker ranges and risk stratification tools in order to improve the diagnosis, treatment, and follow-up in female populations 142 In a recent prospective cohort study, the high sensitivity troponin I assay noticeably increased the diagnosis of MI in women (from 11% to 22%, P<0.001) but had a minimal effect on men (19% to 21%, P=0.002). 143 Other biomarkers, such as proneurotensin, are also found to be sex-specific and related to incident CVD only in women, affirming the need for more research in this area.…”

Section: Ischemic Heart Disease In Womenmentioning

confidence: 99%

Cardiovascular Disease in Women

García

Mulvagh

Merz

et al. 2016

Circulation Research

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Cardiovascular disease (CVD) continues to be the leading cause of death among women in the United States, accounting for approximately one of every three female deaths. Sex-specific data focused on CVD has been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex-differences as they relate to clinical practice in the prevention, diagnosis, and treatment of CVD. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including: myocardial infarction associated with non-obstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other CVD entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease and abdominal aortic aneurysms, are also briefly reviewed. Lastly, recommendations for cardiac rehabilitation are addressed.

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“…In a more contemporary Belgian cohort of STEMI patients who receive primary PCI, the TIMI risk score was effective in predicting in-hospital mortality for both women and men but performed slightly better in men 143 . Although the GRACE score also does not use sex as a parameter because it was not shown to be a statistically significant predictor of hospital mortality during score development 140 , it may improve risk discrimination in women with the additional parameters of creatinine and cardiac arrest at admission, which may reflect sex differences 144 . Recently the GRACE score was studied in a contemporary Spanish cohort with ACS; the discriminative capacity of the GRACE score was significantly lower in women with STEMI compared to men, but inclusion of female sex did not substantially improve the discriminative ability of GRACE score for STEMI patients 145 .…”

Section: Acute Ischemic Heart Diseasementioning

confidence: 99%