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Nedkoff L, Greenland M, Hyun K, Htun JP, Redfern J, Stiles S, Sanfilippo F, Briffa T, Chew DP, Brieger D. Sex- and Age-Specific Differences in Risk Profiles and Early Outcomes in Adults With Acute Coronary Syndromes. Heart Lung Circ 2024; 33:332-341. [PMID: 38326135 DOI: 10.1016/j.hlc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/01/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Adults <55 years of age comprise a quarter of all acute coronary syndromes (ACS) hospitalisations. There is a paucity of data characterising this group, particularly sex differences. This study aimed to compare the clinical and risk profile of patients with ACS aged <55 years with older counterparts, and measure short-term outcomes by age and sex. METHOD The study population comprised patients with ACS enrolled in the AUS-Global Registry of Acute Coronary Events (GRACE), Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) and SNAPSHOT ACS registries. We compared clinical features and combinations of major modifiable risk factors (hypertension, smoking, dyslipidaemia, and diabetes) by sex and age group (20-54, 55-74, 75-94 years). All-cause mortality and major adverse events were identified in-hospital and at 6-months. RESULTS There were 16,658 patients included (22.3% aged 20-54 years). Among them, 20-54 year olds had the highest proportion of ST-elevation myocardial infarction compared with sex-matched older age groups. Half of 20-54 year olds were current smokers, compared with a quarter of 55-74 year olds, and had the highest prevalence of no major modifiable risk factors (14.2% women, 12.7% men) and of single risk factors (27.6% women, 29.0% men), driven by smoking. Conversely, this age group had the highest proportion of all four modifiable risk factors (6.6% women, 4.7% men). Mortality at 6 months in 20-54 year olds was similar between men (2.3%) and women (1.7%), although lower than in older age groups. CONCLUSIONS Younger adults with ACS are more likely to have either no risk factor, a single risk factor, or all four modifiable risk factors, than older patients. Targeted risk factor prevention and management is warranted in this age group.
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Affiliation(s)
- Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | - Melanie Greenland
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, Sydney, NSW, Australia
| | - Jasmin P Htun
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Samantha Stiles
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Frank Sanfilippo
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Tom Briffa
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Derek P Chew
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - David Brieger
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Kumar R, Shaikh AH, Kumar A, Solangi BA, Naseer AB, Awan R, Chachar K, Talpur MFH, Saghir T, Sial JA, Qamar N, Karim M, Hakeem A. Age and gender-based categorization of very premature, premature, and non-premature acute myocardial infarction: A comparison of clinical and angiographic profile and in-hospital outcomes. Int J Cardiol 2023; 391:131292. [PMID: 37625483 DOI: 10.1016/j.ijcard.2023.131292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/27/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND In this study, we aimed to assess and compare the distribution of demographic and clinical characteristics and composite adverse clinical outcomes after primary percutaneous coronary intervention (PCI) among "very premature", "premature", and "non-premature" patients with "ST-segment elevation acute coronary syndrome (STE-ACS)" presented at a tertiary care center. METHODS We included consecutive patients diagnosed with STE-ACS undergoing primary PCI. The "very premature" was defined as ≤40 years for males and ≤ 45 years for females, "premature" as <55 years for males and < 65 years for females, and "non-premature" as ≥55 years for males and ≥ 65 years for females. Clinical characteristics, angiographic patterns, and hospital course were compared among the three groups. RESULTS In a sample of 4686 patients, 78.8%(3691) were male, and the average age was 55.6 ± 11 years. In total, 12%(561) were categorized as very premature, 38.3%(1797) as premature, and 49.7%(2328) as non-premature. The distribution of clinical characteristics in very premature, premature, and non-premature groups were as follows; hypertension in 44.6% vs. 53.5% vs. 54.9%; p < 0.001, diabetes in 30.3% vs. 36.8% vs. 35.5%; p = 0.018, smoking in 29.6% vs. 23.3% vs. 26.3%; p = 0.005, obesity in 19.4% vs. 18.4% vs. 15.3%; p = 0.008, single vessel diseases in 58.8% vs. 37.8% vs. 28.8%; p < 0.001, and composite adverse clinical outcomes in 14.1% vs. 16.7% vs. 21.8%; p < 0.001, respectively. CONCLUSION In conclusion, we have a substantial burden of premature STE-ACS. Very premature STE-ACS was found to be associated with a better prognosis, but a substantial burden of composite adverse clinical outcomes was also observed.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | | | - Ashok Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Ali Bin Naseer
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Romana Awan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kalsoom Chachar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Abdul Hakeem
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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González-Del-Hoyo M, Rodríguez-Leor O, Cid-Álvarez AB, de Prado AP, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Raposeiras-Roubin S, Moreno R, Rossello X. Short-term mortality differs between men and women according to the presence of previous cardiovascular disease: Insights from a nationwide STEMI cohort. Int J Cardiol 2022; 367:90-98. [PMID: 36030132 DOI: 10.1016/j.ijcard.2022.08.036] [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: 04/22/2022] [Revised: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sex and prior cardiovascular disease (CVD) are known independent prognostic factors following an ST-elevation myocardial infarction (STEMI). We aimed to examine whether the association between sex and 30-day mortality differ according to the presence of previous CVD in STEMI patients. METHODS Prospective, observational, multicentre registry of consecutive patients managed in 17 STEMI networks in Spain (83 centres), between April and June 2019. Unadjusted and adjusted logistic regression models assessed the association of 30-day mortality with sex and prior CVD status, as well as their interaction. RESULTS Among 4366 patients (mean age 63.7 ± 13.0 years; 78% male), there were 337 (8.1%) deaths within the first 30 days. There was an association between crude 30-day mortality and sex (women 10.4% vs. men 7.4%, p = 0.003), and prior CVD (CVD 13.7% vs non-CVD 6.8%, p < 0.001). After adjustment for potential confounding, neither sex nor prior CVD were apparently associated with mortality. Nevertheless, we found a significant sex-CVD interaction (p-interaction = 0.006), since women were at lower risk than men in the subset of patients with prior CVD (OR = 0.30, 95%CI = 0.12-0.80) but not in those without CVD (OR = 1.17, 95%CI = 0.79-1.74). CONCLUSIONS Women as well as patients with prior CVD have an increased crude risk of 30-day mortality. However, sex-related differences in short term mortality are modulated by the interaction with CVD in STEMI patients. Compared to men, women had a similar prognosis in the subset of patients without CVD, whereas they were associated with a lower risk of mortality among those with prior CVD after adjusting for other prognostic factors.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Servicio de Cardiología, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Oriol Rodríguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Ana Serrador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José Ramón Rumoroso
- Servicio de Cardiología, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge - IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Borja Ibáñez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge - IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain
| | - Raúl Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital de La Paz, Madrid, Spain
| | - Xavier Rossello
- Servicio de Cardiología, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
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Joseph NM, Ramamoorthy L, Satheesh S. Atypical Manifestations of Women Presenting with Myocardial Infarction at Tertiary Health Care Center: An Analytical Study. J Midlife Health 2021; 12:219-224. [PMID: 34759704 PMCID: PMC8569458 DOI: 10.4103/jmh.jmh_20_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/30/2021] [Accepted: 08/30/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: Typical chest pain symptoms are the cause that requires individuals to seek out medical care in Acute coronary syndrome(ACS). Evidence suggests, symptoms labelled as 'atypical 'is more common in women with ACS. The present study focuses on the need for the implementation of a gender specific approach in the current scenario by identifying gender based differences that exist in clinical presentations of the patients with ACS. Early identification of women's prodromal and acute symptoms of Myocardial Infarction is an important step in provision of appropriate treatment modality. Present study focus on need for implementation of gender-specific approach in current scenario by identifying gender based differences that exist in risk factors, clinical manifestations in patients presenting with MI. Methodology: Cross- sectional analytical study was conducted among 240 Participants (120 males and 120 females). Both men and women diagnosed with MI, who survived, stabilized after admission was included in the study. Consecutive sampling technique was used to select the participants. Data was collected on risk factors profile, clinical manifestations by administering structured questionnaire. Results: Risk factors such as history of diabetes, history of dyslipidemia was found to be homogenous among both men and women. 60% of men were ever smokers. Hypertension and known IHD was noted to be significant in women (p<0.002, p <0.001) but men presented with higher BMI (p<0.030). Females increasingly presented with atypical presentations when compared to males (p<0.005). Women commonly had squeezing and tightness type of pain and men reported tightness, burning, pricking type of pain (p<0.003). The majority of the women reported the onset of pain occurrence between 6am to 12 pm(p<0.004), whereas men significantly reported the onset of pain between 12 am -6 am(p<0.001). Conclusion: Gender based differences in risk factors and clinical presentation in men and women with myocardial infarction had been a focus in researches that emphasized need for focused assessment for women as they increasingly presents with atypical symptoms. The current study also supports the need of a gender specific approach to avoid delay in diagnosis and care of them.
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Affiliation(s)
- Neethu Maria Joseph
- Department of Medical Surgical Nursing, College of Nursing, JIPMER and Department of Cardiology, JIPMER, Puducherry, India
| | - Lakshmi Ramamoorthy
- Department of Medical Surgical Nursing, College of Nursing, JIPMER and Department of Cardiology, JIPMER, Puducherry, India
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Dolezel D, McLeod A, Fulton L. Examining Predictors of Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11284. [PMID: 34769805 PMCID: PMC8583114 DOI: 10.3390/ijerph182111284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 02/05/2023]
Abstract
Cardiovascular diseases are the leading cause of death in the United States. This study analyzed predictors of myocardial infarction (MI) for those aged 35 and older based on demographic, socioeconomic, geographic, behavioral, and risk factors, as well as access to healthcare variables using the Center for Disease (CDC) Control Behavioral Risk Factor Surveillance System (BRFSS) survey for the year 2019. Multiple quasibinomial models were generated on an 80% training set hierarchically and then used to forecast the 20% test set. The final training model proved somewhat capable of prediction with a weighted F1-Score = 0.898. A complete model based on statistically significant variables using the entirety of the dataset was compared to the same model built on the training set. Models demonstrated coefficient stability. Similar to previous studies, age, gender, marital status, veteran status, income, home ownership, employment status, and education level were important demographic and socioeconomic predictors. The only geographic variable that remained in the model was associated with the West North Central Census Division (in-creased risk). Statistically important behavioral and risk factors as well as comorbidities included health status, smoking, alcohol consumption frequency, cholesterol, blood pressure, diabetes, stroke, chronic obstructive pulmonary disorder (COPD), kidney disease, and arthritis. Three access to healthcare variables proved statistically significant: lack of a primary care provider (Odds Ratio, OR = 0.853, p < 0.001), cost considerations prevented some care (OR = 1.232, p < 0.001), and lack of an annual checkup (OR = 0.807, p < 0.001). The directionality of these odds ratios is congruent with a marginal effects model and implies that those without MI are more likely not to have a primary provider or annual checkup, but those with MI are more likely to have missed care due to the cost of that care. Cost of healthcare for MI patients is associated with not receiving care after accounting for all other variables.
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Affiliation(s)
- Diane Dolezel
- Health Information Management Department, Texas State University, San Marcos, TX 78666, USA;
| | - Alexander McLeod
- Computer Information Systems & Quantitative Methods Department, Texas State University, San Marcos, TX 78666, USA;
| | - Larry Fulton
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA
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Murat B, Kivanc E, Dizman R, Ozge Mert G, Murat S. Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40. J Cardiovasc Thorac Res 2021; 13:116-124. [PMID: 34326965 PMCID: PMC8302902 DOI: 10.34172/jcvtr.2021.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. Methods: This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. Results: The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; P = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man (P = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Conclusion: Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.
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Affiliation(s)
- Bektas Murat
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - Eylem Kivanc
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - Rafet Dizman
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
| | - Gurbet Ozge Mert
- Eskisehir Yunus Emre State Hospital Department of Cardiology, Eskisehir, Turkey
| | - Selda Murat
- Eskisehir Osmangazi University, Medical Faculty Department of Cardiology, Eskisehir, Turkey
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Sex-related impacts on clinical outcomes after percutaneous coronary intervention. Sci Rep 2020; 10:15262. [PMID: 32943716 PMCID: PMC7498594 DOI: 10.1038/s41598-020-72296-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to investigate sex-related impacts on clinical outcomes after percutaneous coronary intervention (PCI). We analyzed 90,305 patients (29.0% of women) with the first episode of coronary artery disease who underwent PCI from the Korean National Health Insurance claims database between July 2013 and June 2017. Women were significantly older than men (71.5 ± 10.5 vs. 61.8 ± 11.7 years, p < 0.001). The study population had a median follow-up of 2.2 years (interquartile range, 1.2–3.3). In the propensity-score matched angina population (15,104 pairs), the in-hospital mortality of women was not different from men (odds ratio, 0.87; 95% confidence interval: 0.71–1.08, p = 0.202). However, the post-discharge mortality of women was significantly lower (hazard ratio, 0.74; 95% confidence interval: 0.69–0.80, p < 0.001) than that of men. In the propensity-score matched acute myocardial infarction (AMI) population (8,775 pairs), the in-hospital mortality of women was significantly higher than that of men (odds ratio, 1.19; 95% confidence interval: 1.05–1.34, p = 0.006). Meanwhile, there was no difference in mortality after discharge (hazard ratio, 0.98; 95% confidence interval: 0.91–1.06, p = 0.605). The post-discharge mortality of women was not higher than men under the contemporary PCI treatment. Altered sex-related impacts on clinical outcomes might be attributed to improved medical and procedural strategies.
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Chandrasekhar J, Gill A, Mehran R. Acute myocardial infarction in young women: current perspectives. Int J Womens Health 2018; 10:267-284. [PMID: 29922097 PMCID: PMC5995294 DOI: 10.2147/ijwh.s107371] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.
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Affiliation(s)
- Jaya Chandrasekhar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amrita Gill
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY.,Saint Louis University, St Louis, MO, USA
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Kromer R, Tigges E, Rashed N, Pein I, Klemm M, Blankenberg S. Association between optical coherence tomography based retinal microvasculature characteristics and myocardial infarction in young men. Sci Rep 2018; 8:5615. [PMID: 29618760 PMCID: PMC5884830 DOI: 10.1038/s41598-018-24083-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/27/2018] [Indexed: 01/17/2023] Open
Abstract
Incident myocardial infarction (MI) is a leading cause of adult mortality in the United States. However, because MI has a relatively low incidence in the young population, little information exists on the disease in younger adults. Because the retina has the unique quality that its vasculature is readily and noninvasively visible, the retina is frequently studied to evaluate correlations between vessels and cardiovascular diseases. In the current study, we evaluated the retinal microvasculature of patients who had experienced an MI before 50 years of age (n = 53 subjects) and age- and sex-matched patients who had not experienced an MI (n = 53 patients). We used circular optical coherence tomography (OCT) scans to image peripapillary venules and arterioles. The diameter of each vessel was measured and the respective arterial-venous ratio (AVR) was calculated. We did not detect any significant differences between MI and control subjects in retinal vessel calibre or AVR.
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Affiliation(s)
- Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Eike Tigges
- Department of General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nargis Rashed
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Pein
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Klemm
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
OPINION STATEMENT Despite continued advances in the field, cardiovascular disease remains the leading cause of death in women in the USA with an annual mortality rate that has remained higher for women as compared to men. The factors leading to this sex difference remain incompletely understood. Likely contributors include atypical symptoms at presentation and lack of recognition of cardiovascular risk by women and their providers alike. In addition, women have a higher burden of comorbidities at the time of disease diagnosis and can have differential pathophysiological mechanisms of their acute events. Women also can develop unique cardiovascular risk factors such as preeclampsia and hypertensive disorders of pregnancy. As a result, when women present with symptoms, even atypical, healthcare providers should increase their index level of suspicion for cardiovascular disease. Even after diagnosis, women are less likely to receive guideline-directed medical therapies and be referred for coronary angiography or cardiac rehabilitation. Thus, greater awareness of and research into the aspects of coronary disease that remain unique to women is critical, as women presenting with coronary disease continue to receive disparate care as compared to men. Improvements in awareness and care and new research avenues may reduce the incidence and complications of cardiovascular disease among women.
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Clinical characteristics and prognosis of acute coronary syndrome in young women and men: A systematic review and meta-analysis of prospective studies. Int J Cardiol 2017; 228:837-843. [DOI: 10.1016/j.ijcard.2016.11.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/06/2016] [Indexed: 11/23/2022]
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