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Gauthier V, Montaye M, Ferrières J, Kai SHY, Biasch K, Moitry M, Amouyel P, Dallongeville J, Meirhaeghe A. Sex differences in time trends in acute coronary syndrome management and in 12-month lethality: Data from the French MONICA registries. Int J Cardiol 2022; 361:103-108. [PMID: 35597493 DOI: 10.1016/j.ijcard.2022.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sex differences in clinical presentation, patient care and fatal outcomes after an acute coronary syndrome (ACS) have been reported. However, recent improvements in the care and treatment of ACSs have not been assessed with regard to possible sex differences. AIM To assess sex differences in trends between 2006 and 2016 in the characteristics of ACSs, their management, and the associated mortality. METHODS We assessed all men and women (aged 35-74) covered by the MONICA registries in north, east and south-west France and having been hospitalized for an incident (first) ACS during a 12-month period in 2006 or a 6-month period in 2016. We analyzed the patients' clinical, biochemical, electrocardiographic and care-related data, and their vital status 28 days and 12 months after the ACS. RESULTS In 2006, women were older (<0.0001) and had more atypical symptoms than men (p < 0.01). These differences were no longer statistically significant in 2016. Medical care improved in both men and women. However, revascularization treatment, prescriptions of platelet aggregation inhibitors, statins, and functional rehabilitation were still more frequently provided to men than to women (p < 0.01) in 2016, independently of confounders. The 28-day or 12-month case fatality was not different between men and women in both 2006 and 2016. CONCLUSIONS The results of the present study evidenced an improvement over time in the management of ACS. However, although there were no longer sex differences in the patients' age and clinical presentation, women with ACS were still less likely than men to receive revascularization and pharmacological treatments in 2016.
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Affiliation(s)
- Victoria Gauthier
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Michèle Montaye
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France.; CERPOP, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Samantha Huo Yung Kai
- CERPOP, Université de Toulouse, INSERM, UPS, Toulouse, France.; Department of Epidemiology, Toulouse University Hospital, Toulouse, France
| | - Katia Biasch
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France
| | - Marie Moitry
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France.; Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Amouyel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Jean Dallongeville
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France
| | - Aline Meirhaeghe
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, France..
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Piątek Ł, Wilczek K, Kurzawski J, Gierlotka M, Gąsior M, Poloński L, Sadowski M. Gender-related disparities in the treatment and outcomes in patients with non-ST-segment elevation myocardial infarction: results from the Polish Registry of Acute Coronary Syndromes (PL-ACS) in the years 2012-2014. Arch Med Sci 2020; 16:781-788. [PMID: 32542078 PMCID: PMC7286337 DOI: 10.5114/aoms.2018.76112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/14/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Gender-related differences in the treatment of patients with non-ST elevation myocardial infarction (NSTEMI) have been reported in many previous studies despite the fact that an equal approach is recommended in all current guidelines. The aim of the study was to investigate whether gender-related discrepancies in the management of NSTEMI patients have changed. MATERIAL AND METHODS Between 2012 and 2014 a total of 66,667 patients (38.3% of whom were women) with the final diagnosis of NSTEMI were included into the retrospective analysis of the Polish Registry of Acute Coronary Syndromes (PL-ACS). Differences in clinical profile, treatment, and outcomes were analysed. RESULTS Women were older than men and more often had comorbidities. They were less likely to undergo coronary angiography (88.4% vs. 92.1%, p < 0.05) as well as percutaneous coronary intervention (59.6% vs. 71.9%, p < 0.05). In the general population women had also significantly worse in-hospital prognosis as well as in 12-month follow-up. After the age adjustment the outcomes in women were at least as good as in men. In multivariate analysis females had the same risk as men in-hospital RR = 1.02 (95% CI: 0.97-1.08, p = 0.45) and lower in 12-month observation RR = 0.94 (95% CI: 0.92-0.97, p < 0.0001). CONCLUSIONS In comparison with previous reports on NSTEMI patients, gender-related disparities in the treatment and outcomes were radically reduced. Unadjusted mortality rates were still higher in women as a consequence of their older age. After the age adjustment, mortality ratios were similar in both genders. The long-term prognosis seems to be even better in women.
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Affiliation(s)
- Łukasz Piątek
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Department of Anatomy, Kielce, Poland
- 2 Department of Cardiology, Świętokrzyskie Cardiology Centre, Kielce, Poland
- Corresponding author: Łukasz Piątek MD, 2 Department of Cardiology, Świętokrzyskie Cardiology Centre, 45 Grunwaldzka St, 25-736 Kielce, Poland, E-mail:
| | - Krzysztof Wilczek
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Jacek Kurzawski
- 2 Department of Cardiology, Świętokrzyskie Cardiology Centre, Kielce, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medicine, University of Opole, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Lech Poloński
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Marcin Sadowski
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Department of Anatomy, Kielce, Poland
- Catheterisation Laboratory, Świętokrzyskie Cardiology Centre, Kielce, Poland
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Marie D, Mingou JS, Dia K, Gbadamassi SEOK, Fall PD, Diao M, Mboup MC. Clinical Presentation, Risk Factor, and Outcomes of Acute Coronary Syndrome in Women at an Urban Referral Center in Dakar, Senegal. Glob Heart 2019; 14:35-39. [PMID: 30905691 DOI: 10.1016/j.gheart.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/03/2018] [Accepted: 01/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease is on the rise in Sub-Saharan countries. Recently, consistent studies have reported sex differences in the epidemiology of acute coronary syndrome (ACS). Although, data on the incidence of ACS in Sub-Saharan countries are not rare, few focused closely on women. OBJECTIVES The purpose of this study was to examine risk factors, clinical presentations, and management strategies in women with ACS. METHODS This was a retrospective study conducted at the Cardiology Department of Principal Hospital of Dakar over a period of 60 months (January 1, 2010, to December 31, 2014), in Dakar, Senegal. Medical records of female subjects admitted for ACS on the basis of anginal pain at rest, suggestive electrocardiographic changes, and elevated troponin I levels were included. We collected and analyzed the epidemiological, clinical, paraclinical, and evolutionary data of the patients. RESULTS Hospital prevalence of ACS in women was 2.32%, meaning 38.1% of patients were admitted for ACS during the same period. The mean age of patients was 68.8 ± 9.5 years; 52% of them were aged between 60 and 69 years. The risk factors in our patients were dominated by hypertension found (63.3%) and diabetes (54.1%). Active smoking was found in 6 patients (6.1%). One-half of patients had more than 1 risk factor. Chest pain was present in 94 patients (95.9%). The average time delay before medical care was administered was 53.9 ± 18 h. Thirty patients showed signs of left ventricular failure (Killip classes I and II). Electrocardiography revealed ACS with persistent ST-segment elevation in 53 patients (54.1%) and non-ST-segment elevation ACS in 45 patients (45.9%). Mean troponin I level was 1.68 ± 2.3 ng/ml. Doppler echocardiography revealed impaired segmental kinetics in more than one-half of patients. The mean ventricular ejection fraction was 43.8 ± 10.1%. Thrombolysis was performed in 10 patients, accounting for 10.2% of patients with ST-segment elevation. The evolution during hospitalization after a mean hospital stay of 9.5 ± 3.7 days was favorable in 66 patients (67.3%). Six deaths (6.1%) were recorded. Complications was dominated by pulmonary edema. CONCLUSIONS Our study confirms that ACS is not a "man's only" disease in Sub-Saharan countries. The major concern is that there appeared to be continuing evidence of suboptimal treatment and intervention in women with ACS in current practice.
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Affiliation(s)
- Djibril Marie
- Department of Cardiology and Internal Medication, Military Hospital of Ouakam, Dakar, Senegal.
| | - Joseph S Mingou
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Khadidiatou Dia
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | | | - Pape D Fall
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Maboury Diao
- Department of Cardiology, University Cheickh Anta Diop, Dakar, Senegal
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Mboup MC, Mingou J, Ba DM, Dia K, Fall PD. [Characteristics of acute coronary syndromes in Sub-Saharan African women]. Ann Cardiol Angeiol (Paris) 2018; 68:115-119. [PMID: 30314668 DOI: 10.1016/j.ancard.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 09/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar. METHODOLOGY This was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar. RESULTS The prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P=0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer (=0.005). Therapeutically, medical care was almost identical regardless of gender. CONCLUSION In Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign.
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Affiliation(s)
- M C Mboup
- Service de cardiologie, hôpital Principal de Dakar, 1, avenue Nelson-Mandela, Dakar, Sénégal.
| | - J Mingou
- Service de cardiologie, hôpital Principal de Dakar, 1, avenue Nelson-Mandela, Dakar, Sénégal
| | - D M Ba
- Service de cardiologie, hôpital Principal de Dakar, 1, avenue Nelson-Mandela, Dakar, Sénégal
| | - K Dia
- Service de cardiologie, hôpital Principal de Dakar, 1, avenue Nelson-Mandela, Dakar, Sénégal
| | - P D Fall
- Service de cardiologie, hôpital Principal de Dakar, 1, avenue Nelson-Mandela, Dakar, Sénégal
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Thang ND, Karlson BW, Karlsson T, Herlitz J. Characteristics of and outcomes for elderly patients with acute myocardial infarction: differences between females and males. Clin Interv Aging 2016; 11:1309-1316. [PMID: 27703339 PMCID: PMC5036828 DOI: 10.2147/cia.s110034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives This study analyzed age-adjusted sex differences among acute myocardial infarction (AMI) patients aged 75 years and above with regard to 7-year mortality (primary end point) and the frequency of angiograms and admission to the coronary care unit (CCU) as well as 1-year mortality (secondary end points). Methods A retrospective cohort study comprised 1,414 AMI patients (748 females and 666 males) aged at least 75 years, who were admitted to Sahlgrenska University Hospital in Gothenburg, Sweden, during two periods (2001/2002 and 2007). All comparisons between female and male patients were age adjusted. Results Females were older and their previous history included fewer AMIs, coronary artery bypass grafting procedures, and renal diseases, but more frequent incidence of hypertension. On the contrary, males had higher age-adjusted 7-year mortality in relation to females (hazard ratio [HR] 1.16 with corresponding 95% confidence interval [95% CI 1.03, 1.31], P=0.02). Admission to the CCU was more frequent among males than females (odds ratio [OR] 1.38 [95% CI 1.11, 1.72], P=0.004). There was a nonsignificant trend toward more coronary angiographies performed among males (OR 1.34 [95% CI 1.00, 1.79], P=0.05), as well as a nonsignificant trend toward higher 1-year mortality (HR 1.18 [95% CI 0.99, 1.39], P=0.06). Conclusion In an AMI population aged 75 years and above, males had higher age-adjusted 7-year mortality and higher rate of admission to the CCU than females. One-year mortality did not differ significantly between the sexes, nor did the frequency of performed coronary angiograms.
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Affiliation(s)
- Nguyen Dang Thang
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg
| | - Björn Wilgot Karlson
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg; AstraZeneca R&D, Mölndal
| | - Thomas Karlsson
- Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg; School of Health Sciences, Research Centre PreHospen, University of Borås, The Pre-hospital Research Centre of Western Sweden, Borås, Sweden
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