TY - JOUR
T1 - Differences in management and outcomes for men and women with ST-elevation myocardial infarction
AU - Khan, Ehsan
AU - Brieger, David
AU - Amerena, John
AU - Atherton, John J.
AU - Chew, Derek P.
AU - Farshid, Ahmad
AU - Ilton, Marcus
AU - Juergens, Craig P.
AU - Kangaharan, Nadarajah
AU - Rajaratnam, Rohan
AU - Sweeny, Amy
AU - Walters, Darren L.
AU - Chow, Clara K.
PY - 2018
Y1 - 2018
N2 - Objective: To examine whether there are sex differences in the characteristics, management, and clinical outcomes of patients with an ST-elevation myocardial infarction (STEMI). Design, setting: Cohort study; analysis of data collected prospectively by the CONCORDANCE acute coronary syndrome registry from 41 Australian hospitals between February 2009 and May 2016. Participants: 2898 patients (2183 men, 715 women) with STEMI. Main outcome measures: Rates of revascularisation (percutaneous coronary intervention [PCI], thrombolysis, coronary artery bypass grafting [CABG]), adjusted for GRACE risk score quartile. Secondary outcomes: timely vascularisation rates; major adverse cardiac event rates; clinical outcomes and preventive treatments at discharge. Results: The mean age of women with STEMI at presentation was 66.6 years (SD, 14.5 years), of men, 60.5 years (SD, 12.5 years). The proportions of women with hypertension, diabetes, prior stroke, chronic kidney disease, chronic heart failure, or dementia were larger than those of men; fewer women had histories of previous coronary artery disease or myocardial infarction, or of prior PCI or CABG. Women were less likely to have undergone coronary angiography (odds ratio, adjusted for GRACE score quartile [aOR], 0.53; 95% CI, 0.41−0.69) or revascularisation (aOR, 0.42; 95% CI, 0.34−0.52); they were less likely to have received timely revascularisation (aOR, 0.72; 95% CI, 0.63−0.83) or primary PCI (aOR, 0.76; 95% CI, 0.61−0.95). Six months after admission, the rates of major adverse cardiovascular events (aOR, 2.68; 95% CI, 1.76−4.09) and mortality (aOR, 2.17; 95% CI, 1.24−3.80) were higher for women. At discharge, significantly fewer women than men received β-blockers, statins, and referrals to cardiac rehabilitation. Conclusion: Women with STEMI are less likely to receive invasive management, revascularisation, or preventive medication at discharge. The reasons for these persistent differences in care require investigation.
AB - Objective: To examine whether there are sex differences in the characteristics, management, and clinical outcomes of patients with an ST-elevation myocardial infarction (STEMI). Design, setting: Cohort study; analysis of data collected prospectively by the CONCORDANCE acute coronary syndrome registry from 41 Australian hospitals between February 2009 and May 2016. Participants: 2898 patients (2183 men, 715 women) with STEMI. Main outcome measures: Rates of revascularisation (percutaneous coronary intervention [PCI], thrombolysis, coronary artery bypass grafting [CABG]), adjusted for GRACE risk score quartile. Secondary outcomes: timely vascularisation rates; major adverse cardiac event rates; clinical outcomes and preventive treatments at discharge. Results: The mean age of women with STEMI at presentation was 66.6 years (SD, 14.5 years), of men, 60.5 years (SD, 12.5 years). The proportions of women with hypertension, diabetes, prior stroke, chronic kidney disease, chronic heart failure, or dementia were larger than those of men; fewer women had histories of previous coronary artery disease or myocardial infarction, or of prior PCI or CABG. Women were less likely to have undergone coronary angiography (odds ratio, adjusted for GRACE score quartile [aOR], 0.53; 95% CI, 0.41−0.69) or revascularisation (aOR, 0.42; 95% CI, 0.34−0.52); they were less likely to have received timely revascularisation (aOR, 0.72; 95% CI, 0.63−0.83) or primary PCI (aOR, 0.76; 95% CI, 0.61−0.95). Six months after admission, the rates of major adverse cardiovascular events (aOR, 2.68; 95% CI, 1.76−4.09) and mortality (aOR, 2.17; 95% CI, 1.24−3.80) were higher for women. At discharge, significantly fewer women than men received β-blockers, statins, and referrals to cardiac rehabilitation. Conclusion: Women with STEMI are less likely to receive invasive management, revascularisation, or preventive medication at discharge. The reasons for these persistent differences in care require investigation.
UR - https://hdl.handle.net/1959.7/uws:63634
U2 - 10.5694/mja17.01109
DO - 10.5694/mja17.01109
M3 - Article
SN - 0025-729X
VL - 209
SP - 118
EP - 123
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 3
ER -
