Treatment of Acute Myocardial Infarction and 30-Day Mortality among Women and Men

Gan, Sandra C.; Beaver, Shelli K.; Houck, Peter M.; MacLehose, Richard F.; Lawson, Herschel W.; Chan, Leighton

doi:10.1056/nejm200007063430102

Cited by 315 publications

(224 citation statements)

References 47 publications

(58 reference statements)

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“…Although this is a high rate of thrombolysis compared to other studies, 2,[24][25] it still implies that we are failing to administer this life-saving treatment to around 20% of the patients who would benefit from it.…”

Section: Discussionmentioning

confidence: 93%

“…However, It has been shown that women were less likely to receive medical treatment and invasive cardiac procedures. [2][3][4][5][6][7][8][9]21) Another possible explanation for this increased mortality is that younger women had more risk factors for coronary artery disease than did younger men and were more likely to have a history of congestive heart failure and a higher Killip class on presentation. Of special importance is a significantly higher risk of diabetes in women, which has been shown to be an independent poor prognostic factor in patients with AMI [26][27][28] Other possible explanations include sex differences in the pathophysiology of coronary artery disease 29) or differences in thrombotic and fibrinolytic activity.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] have shown that women with AMI tend to be older than men and are more likely to have a history of hypertension, diabetes, hypercholesetrolemia and congestive heart failure. Women on the other hand are less likely to be smokers.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Most studies have reported higher mortality among women, [10][11][12][13][14][15][16][17] while others have reported similar mortality rates among men and women. 2,[18][19][20][21] It is unclear whether the noticed gender differences in treatment and outcome following AMI are related to differences in baseline clinical characteristics, gender-bias in treatment administration, or to pathophysiological differences between women and men.…”

mentioning

confidence: 99%

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Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Zubaid

Rashed²,

Thalib

et al. 2001

Jpn Heart J

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SUMMARYThere is evidence for gender differences in the treatment and outcome of acute myocardial infarction (AMI). However, little data exist about these differences in patients from the Arab Middle East. Therefore, we studied the influence of patient gender on the presentation, the use of thrombolytic therapy, and in-hospital mortality after AMI in Kuwaiti nationals. This is a retrospective study of all consecutive Kuwaiti patients admitted to the coronary care unit of a university hospital with the diagnosis of AMI between June 1994 and May 1997. A total of 89 women and 267 men were included. Women were older than men and had significantly higher rates of diabetes (72% vs 46%), hypertension (58% vs 33%) and hypercholesterolemia (80% vs 53%). Women were less likely to receive thrombolytic therapy (40% vs 62%, p=0.001). Fewer women were eligible for thrombolytic therapy (50% vs 66%, p<0.05). Of those who were eligible for thrombolysis there was no sex difference in receiving such treatment. The in-hospital mortality among women younger than 70 years was 2.5 times higher than among men in the same age group; while there was no difference in mortality between women and men aged 70 years and older. We conclude that women and men with AMI have different clinical characteristics and outcomes following AMI. There was no gender bias for the use of thrombolytic therapy. The higher in-hospital mortality in younger women, i.e. less than 70 years, compared to younger men, indicates that younger women with AMI should be considered as a high-risk group. (Jpn Heart J 2001; 42: 669-676) Key words: Myocardial infarction, Gender, Thrombolytic therapy, Outcome, Middle East HEART disease is a leading cause of death in Kuwait. In 1995, coronary artery disease was responsible for 15.4% of all deaths among Kuwaitis and 23.6% of all deaths among expatriates. 1) Although coronary artery disease is more prevalent in men, it is the leading cause of death in women as in men. Several studies have assessed sex-based differences in treatment and mortality following AMI. It has From the

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Zubaid

Rashed²,

Thalib

et al. 2001

Jpn Heart J

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“…A recognition of sex differences in the treatment of myocardial infarction in the late 1990s and early 2000s4, 5, 6 in the United States led to national campaigns7 and female‐specific guidelines 8, 9, 10. Subsequently, sex gaps in care have narrowed over time 5, 11.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST‐Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)‐Retrospective Study

Du¹,

Spatz²,

Dreyer

et al. 2016

JAHA

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BackgroundChina is experiencing a marked increase in ST‐segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in‐hospital death in relatively younger age groups (<70). Yet, little is known about sex differences in ST‐segment elevation myocardial infarction presentation and management.Methods and ResultsIn a nationally representative sample of patients with ST‐segment elevation myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006, and 2011, we examined sex differences in hospitalization rates, clinical profiles, and quality of care. Among 11 986 patients, the proportion of women was unchanged between 2001 and 2011. The estimated national rates of hospital admission per 100 000 people increased from 4.6 in 2001 to 18.0 in 2011 among men (3.9‐fold increase) and from 1.9 to 8.0 among women (4.2‐fold increase) (P trend<0.0001). The median age of women increased from 68 years in 2001 to 72 years in 2011 (P trend<0.001); however, there was no age change in men (63 years in 2011) (P trend=0.48). After accounting for age, women had a higher frequency of comorbidities. Although there were significant sex differences in the time interval of >12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence‐based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P<0.001 for all) and the differences were largely unchanged over time.ConclusionsWomen experienced a higher increase in hospitalization rates for ST‐segment elevation myocardial infarction in China between 2001 and 2011 and were less likely to receive evidence‐based therapies, especially reperfusion. In addition to efforts to improve quality of care generally, understanding the reasons for this sex disparity and addressing these differences in care should be a priority.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

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Use of Cholesterol-Lowering Therapy by Elderly Adults After Myocardial Infarction

Ayanian¹,

Landrum²,

McNeil³

2002

Arch Intern Med

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Treatment of Acute Myocardial Infarction and 30-Day Mortality among Women and Men

Abstract: As compared with men, women receive somewhat less aggressive treatment during the early management of acute myocardial infarction. However, many of these differences are small, and there is no apparent effect on early mortality.

Cited by 315 publications

References 47 publications

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST‐Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)‐Retrospective Study

Use of Cholesterol-Lowering Therapy by Elderly Adults After Myocardial Infarction

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