Stéphane Manzo-Silberman1, Francis Couturaud2, Sandrine Charpentier3, Vincent Auffret4, Carlos El Khoury5, Hervé Le Breton4, Loïc Belle6, Stéphanie Marlière7, Marianne Zeller8, Yves Cottin9, Nicolas Danchin10, Tabassome Simon11, François Schiele12, Martine Gilard13. 1. Department of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France. Electronic address: stephane.manzosilberman@aphp.fr. 2. Department of Internal Medicine and Chest Diseases, EA3878, CIC-INSERM1412, Brest University Hospital, European University of Occidental Brittany, Brest, France. 3. Emergency Department, Rangueil University Hospital, Toulouse, France; Toulouse III Paul Sabatier University, Toulouse, France; Team 5, INSERM UMR 1027, Toulouse, France. 4. Cardiology and Vascular Diseases Department, Rennes University Hospital, Rennes, France; Rennes 1 University, LTSI, Rennes F-35000, France; 3 INSERM, U1099, Rennes, France. 5. Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France. 6. Cardiology Department, Annecy Hospital, Annecy, France. 7. Cardiology Department, University Hospital, Grenoble, France. 8. Laboratory of Cardiometabolic Physiopathology and Pharmacology, University of Burgundy, Dijon, France. 9. Department of Cardiology, University Hospital, Dijon, France. 10. Department of Cardiology, Hôpital Europeen Georges Pompidou, Paris Hospitals Board (AP-HP), Paris, France; Paris V University, Paris, France. 11. Department of Pharmacology-URCEST, Paris Hospitals Board (AP-HP), Paris, France; UPMC-Paris 06, Paris, France; INSERM U-1148, Paris, France. 12. Department of Cardiology, University Hospital Jean Minjoz, EA3920, Besançon, France. 13. Cardiology Department, Brest University Hospital, EA 4324, European University of Occidental Brittany, Brest, France.
Abstract
BACKGROUND: Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population. METHODS AND RESULTS: We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility. Primary study outcomes were STEMI, patient and system, delays. Secondary outcome was in-hospital mortality. 16,733 patients were included with 4021 females (24%). Women were significantly older (mean age 70.6 vs 60.6), with higher diabetes (19.6% vs 15.4%) and hypertension rates (58.7% vs 38.8%). Patient delay was longer in women with adjusted mean difference of 14.4 min (p < 0.001); system delay did not differ. In-hospital death occurred 3 times more in women. This disadvantage persisted strongly adjusting for age, therapeutic strategy and delay with a 1.85 (1.32-2.61) adjusted hazard ratio. CONCLUSIONS: This overview of 16,733 real-life consecutive STEMI patients in prospective registries over an extensive period strongly indicates gender-related discrepancies, highlighting clinically relevant delays in seeking medical attention. However, higher in-hospital mortality was not totally explained by clinical characteristics or delays. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
BACKGROUND:Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population. METHODS AND RESULTS: We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility. Primary study outcomes were STEMI, patient and system, delays. Secondary outcome was in-hospital mortality. 16,733 patients were included with 4021 females (24%). Women were significantly older (mean age 70.6 vs 60.6), with higher diabetes (19.6% vs 15.4%) and hypertension rates (58.7% vs 38.8%). Patient delay was longer in women with adjusted mean difference of 14.4 min (p < 0.001); system delay did not differ. In-hospital death occurred 3 times more in women. This disadvantage persisted strongly adjusting for age, therapeutic strategy and delay with a 1.85 (1.32-2.61) adjusted hazard ratio. CONCLUSIONS: This overview of 16,733 real-life consecutive STEMI patients in prospective registries over an extensive period strongly indicates gender-related discrepancies, highlighting clinically relevant delays in seeking medical attention. However, higher in-hospital mortality was not totally explained by clinical characteristics or delays. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
Authors: T Kerkman; L B G Ten Brinke; B Huybrechts; R Adams; G Amoroso; R J de Winter; Y Appelman Journal: Neth Heart J Date: 2020-11 Impact factor: 2.380
Authors: Cinzia Perrino; Péter Ferdinandy; Hans E Bøtker; Bianca J J M Brundel; Peter Collins; Sean M Davidson; Hester M den Ruijter; Felix B Engel; Eva Gerdts; Henrique Girao; Mariann Gyöngyösi; Derek J Hausenloy; Sandrine Lecour; Rosalinda Madonna; Michael Marber; Elizabeth Murphy; Maurizio Pesce; Vera Regitz-Zagrosek; Joost P G Sluijter; Sabine Steffens; Can Gollmann-Tepeköylü; Linda W Van Laake; Sophie Van Linthout; Rainer Schulz; Kirsti Ytrehus Journal: Cardiovasc Res Date: 2021-01-21 Impact factor: 10.787