After acute myocardial infarction, most but not all women have better prognosis than menLiterature - Redfors et al., J Am Heart Assoc. 2015
Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART)
Redfors B, Angerås O, Råmunddal T, et al.
J Am Heart Assoc. 2015;4:e001995. Originally published July 14, 2015
BackgroundWomen show a decades-long delay of the onset of clinical CV disease, thus appear to have biological protection from coronary artery disease . Some reports on mortality after an acute myocardial infarction (AMI) suggest that women do not show a similarly effective reduction as men over the past decades [2-6]. It is currently debated whether sex-specific differences exist in clinical course, diagnosis and management of ischaemic heart disease, and whether a change in clinical praxis could change this.
The Swedish national medical and health care quality registry SWEDEHEART , containing individualised data was used to compare mortality, risk of complications, and likelihood of receiving evidence-based treatment for men and women who experienced an AMI. Data of 48 118 patients from 11 cardiac units in Västra Götaland County were included, 35.4% of whom were women.
- Between 1995 and 2013, in-hospital, 30-day and 1-year mortality decreased. The adjusted reduction over time did not differ significantly between men and women.
Unadjusted mortality rates were higher in women, but women were older on average.
- A risk factor-adjusted Cox proportional hazards regression model on imputed data revealed that women diagnosed with AMI had a lower risk of dying than men (HR: 0.94, 95%CI: 0.91-0.96, P<0.001).
- A significant interaction was observed between gender and age, and gender and type of MI (STEMI or NSTEMI). Long- and short-term prognosis was better in older women than older men, but in young age categories prognosis was similar. And women with NSTEMI had better prognosis than men, while prognosis was similar for both genders for STEMI.
Younger women with STEMI had a particularly high risk.
- After the introduction of primary PCI as reperfusion therapy of choice, a similar risk of death within 30 days reduction was seen for men and women, although a trend towards better risk reduction in men was observed (P=0.055 for interaction between gender and time).
- Risk to develop prehospital cardiogenic shock was larger in younger women than in younger men (adjOR: 1.67, 95%CI: 1.30-2.16). Women with STEMI had a higher risk for cardiogenic shock (OR: 1.31, 95%CI: 1.16-1.48), while women with NSTEMI had not (OR: 0.92, 95%CI: 0.82-1.04).
- Women had a higher risk of being treated for in-hospital heart failure, as well as for major bleeding than men.
- Women with STEMI were less likely to undergo coronary angiography than men with STEMI (OR: 0.72, 95%CI: 0.57-0.90).
- Women were more likely to not be prescribed evidence-based pharmacological treatment, which was stable over time.
ConclusionThis study into data from the prospective RIKS-HIA registry showed that, in general, women have better prognosis than men after AMI, although younger women or women with STEMI did not show this benefit. Throughout the study period, women less often received evidence-based treatment after discharge from the hospital, and were less likely to undergo coronary angiography.
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1. Tillmanns H, Waas W, Voss R, et al. Gender differences in the outcome of cardiac interventions. Herz. 2005;30:375–389.
2. Schmidt M, Jacobsen JB, Lash TL, et al. 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ. 2012;344:e356.
3. Koopman C, Bots ML, van Oeffelen AA, et al. Population trends and inequalities in incidence and short-term outcome of acute myocardial infarction between 1998 and 2007. Int J Cardiol. 2013;168:993–998.
4. Dudas K, Lappas G, Rosengren A. Long-term prognosis after hospital admission for acute myocardial infarction from 1987 to 2006. Int J Cardiol. 2012;155:400–405.
5. Smolina K, Wright FL, Rayner M, et al. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study. BMJ. 2012;344:d8059.
6. Vaccarino V, Parsons L, Every NR, et al. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 1999;341:217–225.
7. Jernberg T, Attebring MF, Hambraeus K et al. The Swedish web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Heart. 2010;96:1617–1621.