Guillaume Leurent1, Ronan Garlantézec2, Vincent Auffret3, Jean Philippe Hacot4, Isabelle Coudert5, Emmanuelle Filippi6, Antoine Rialan7, Benoît Moquet8, Gilles Rouault9, Martine Gilard10, Philippe Castellant10, Philippe Druelles11, Bertrand Boulanger12, Josiane Treuil13, Bertrand Avez14, Marc Bedossa3, Dominique Boulmier3, Marielle Le Guellec3, Hervé Le Breton3. 1. Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France. Electronic address: guillaume.leurent@chu-rennes.fr. 2. École des Hautes Études en Santé Publique, Rennes, France. 3. Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France. 4. Centre Hospitalier de Lorient, Service de Cardiologie, Lorient, France. 5. CHU de Rennes, SAMU, Rennes, France. 6. Centre Hospitalier de Vannes, Service de Cardiologie, Vannes, France. 7. Centre Hospitalier de Saint-Malo, Service de Cardiologie, Saint-Malo, France. 8. Centre Hospitalier de Saint-Brieuc, Service de Cardiologie, Saint-Brieuc, France. 9. Centre Hospitalier de Quimper, Service de Cardiologie, Quimper, France. 10. CHU de Brest, Service de Cardiologie, Brest, France; EA 4324 - Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France. 11. Clinique Saint-Laurent, Service de Cardiologie, Rennes, France. 12. Centre Hospitalier de Vannes, SAMU, Vannes, France. 13. CHU de Brest, SAMU, Brest, France. 14. Centre Hospitalier de Saint-Brieuc, SAMU, Saint-Brieuc, France.
Abstract
BACKGROUND: Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported. AIM: To determine whether female gender is associated with higher inhospital mortality. METHODS: Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men). RESULTS: The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; P<0.05). Reperfusion strategies in women less frequently involved fibrinolysis, coronary angiography, radial access and thrombo-aspiration. Female gender, especially in patients aged<60 years, was associated with poorer inhospital prognosis (including higher inhospital mortality: 9% vs. 4% in men; P<0.0001), and underutilization of recommended treatments at discharge. Moreover, excess female inhospital mortality was independent of presentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04). CONCLUSIONS: One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality.
BACKGROUND: Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported. AIM: To determine whether female gender is associated with higher inhospital mortality. METHODS: Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men). RESULTS: The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; P<0.05). Reperfusion strategies in women less frequently involved fibrinolysis, coronary angiography, radial access and thrombo-aspiration. Female gender, especially in patients aged<60 years, was associated with poorer inhospital prognosis (including higher inhospital mortality: 9% vs. 4% in men; P<0.0001), and underutilization of recommended treatments at discharge. Moreover, excess female inhospital mortality was independent of presentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04). CONCLUSIONS: One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality.
Authors: Kshipra Hemal; Neha J Pagidipati; Adrian Coles; Rowena J Dolor; Daniel B Mark; Patricia A Pellikka; Udo Hoffmann; Sheldon E Litwin; Melissa A Daubert; Svati H Shah; Kevin Ariani; Renée P Bullock-Palmer; Beth Martinez; Kerry L Lee; Pamela S Douglas Journal: JACC Cardiovasc Imaging Date: 2016-04
Authors: Robert O Roswell; Jordan Kunkes; Anita Y Chen; Karen Chiswell; Sohah Iqbal; Matthew T Roe; Sripal Bangalore Journal: J Am Heart Assoc Date: 2017-01-11 Impact factor: 5.501
Authors: Luke K Kim; Patrick Looser; Rajesh V Swaminathan; James Horowitz; Oren Friedman; Ji Hae Shin; Robert M Minutello; Geoffrey Bergman; Harsimran Singh; S Chiu Wong; Dmitriy N Feldman Journal: J Am Heart Assoc Date: 2016-06-22 Impact factor: 5.501