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European Society of Cardiology

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Women more likely to die from MI than men

Women are more likely to die from a myocardial infarction (MI) than men, according to research presented at the Acute Cardiac Care Congress 2012, held recently in Istanbul. The gender gap in mortality was independent of patient characteristics, revascularisation delays and revascularisation modalities. Women also had longer treatment delays, less aggressive treatment, more complications and longer hospital stays.

Researchers led by Dr Guillaume Leurent (Centre Hospitalier Universitaire, Rennes, France) analysed data from 5,000 patients included in the ORBI registry (Observatoire Régional Breton sur l’Infarctus du myocarde; Brittany regional observational study on myocardial infarction) over a 6-year period. They found that 1,174 patients (23.5%) were women. Female ST elevation MI (STEMI) patients were older, with an average age of 69 years compared to 61 years for men. Women had more frequent hypertension, less dyslipidemia and less current smoking.

The researchers found significant differences in the management and outcome of STEMI patients according to gender.

Women had longer median delays between symptom onset and call for medical assistance (60 vs 44 minutes, p<0.0001) and between admission and reperfusion (45 vs 40 minutes, p=0.011).

“Delays of management are significantly longer in women, hence they have a longer ischaemic time during which the heart’s blood supply is reduced,” said Dr Leurent. “And reperfusion strategies to restore blood flow are significantly less aggressive – with less fibrinolysis, and fewer coronary angiographies performed.”

Intra-hospital mortality was higher in women (9.0% vs 4.0%, p<0.0001). The researchers used three adjustment models to determine whether the higher intra-hospital mortality among women was solely due to gender or whether it was due to other factors such as patient characteristics (age, hypertension, smoking, etc) or management.

Dr Leurent said: “This higher intra-hospital mortality among women significantly persists when adjusted for patient characteristics, for revascularisation delays (onset of symptoms to reperfusion therapy) and for revascularisation modalities.”

Women had more STEMI complications including atrial fibrillation (7% vs 3%, p<0.0001) and longer hospital stays (7.6+4 vs 6.7+4 days, p<0.0001).

Women received significantly less of the recommended treatments at discharge. Specifically, they received less antiplatelet agents, beta blockers, ACE inhibitors and statins. They also received less cardiovascular rehabilitation (27% of women vs 47% of men, p<0.0001).

Dr Leurent said: “Women may take longer to call an ambulance when they have chest pains because they don’t believe it can be a MI. Most women believe MI is a male problem.”

“Many doctors still think MI is a male problem,” continued Dr Leurent. “Campaigns are needed to increase awareness in doctors and the public about the problem of STEMI in women.”

He concluded: “Doctors need to be more careful in the management of STEMI in women to further reduce ischaemic time. This means adopting more aggressive reperfusion strategies and treating women the same as men. These actions by patients and doctors will reduce the current gender gap in mortality.”

References

1. Leurent G, Moquet B, Coudert I, et al. Are there gender differences in the management of ST-elevation myocardial infarction? Data from ORBI, a prospective registry of 5,000 patients. Eur Heart J: Acute Cardiovascular Care Abstract Supplement 2012;1(S1):103.

Published on: October 19, 2012

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