French Registry: Women with STEMI Fare Worse Than Male Counterparts


Women are almost twice as likely as men to die in the hospital following an ST-segment elevation myocardial infarction (STEMI), according to a French registry study presented October 20, 2012, at the Acute Cardiac Care Congress in Istanbul, Turkey. The findings also show that women have longer treatment delays, less aggressive management, and more complications.

Guillaume Leurent, MD, of the Centre Hospitalier Universitaire de Rennes (Rennes, France), and colleagues looked for differences in care between the sexes among 5,000 STEMI patients enrolled in the prospective ORBI registry over a 6-year period beginning July 2006. The patients presented to 9 interventional centers in Brittany, France, within 24 hours of symptom onset.

Women Start Off at a Disadvantage

Compared with men, women experienced longer delays between symptom onset and call for medical assistance (median 60 minutes vs. 44 minutes; P < 0.0001) and between hospital admission and reperfusion (median 45 minutes vs. 40 minutes; P = 0.011).

In-hospital management of women was less aggressive. They were less likely to receive fibrinolysis, glycoprotein IIb/IIIa inhibitors, or angiography. They were also less likely to undergo PCI via radial access. However, there was no difference between the sexes in rates of primary PCI and thrombus aspiration (table 1).

Table 1. Management of Men vs. Women

 

Men
(n = 3,826)

Women
(n = 1,174)

P Value

Fibrinolysis

16%

12%

0.001

GP IIb/IIIa Inhibitors

59%

53%

< 0.0001

Angiography

98%

95%

< 0.0001

Radial Access

51%

38%

< 0.0001

Primary PCI

72%

70%

0.36

Thrombus Aspiration

47%

43%

0.075


Women also fared worse than men in the hospital, with higher rates of mortality, high-degree atrioventricular (AV) block and A-fib, as well as lower LVEF and longer stay (table 2).

Table 2. In-Hospital Outcomes

 

Men
(n = 3,826)

Women
(n = 1,174)

P Value

Death

4.4%

9.0%

< 0.0001

High-Degree AV Block

2%

5%

< 0.0001

A-fib

3%

7%

< 0.0001

LVEF

50.5 ± 10%

49.4 ± 11%

0.004

Length of Stay, days

6.7 ± 4

7.6 ± 4

< 0.0001


According to Dr. Leurent, women’s higher in-hospital mortality persisted after adjustment for patient characteristics as well as delay in and type of revascularization.

In addition, women were less often prescribed evidence-based medications at discharge including aspirin, thienopyridines, beta blockers, ACE inhibitors, and statins (all at least P = 0.001). They were also less likely than men to be referred for cardiac rehabilitation (27% vs. 47%; P < 0.0001).

STEMI Not Only a Male Issue

“These results suggest that women need to be more vigilant about chest pains and request medical help quickly to reduce ischemic time,” Dr. Leurent observed in a press release. He added that women may take longer to call an ambulance when they have chest pains because they associate MIs with men.

Many doctors have the same mindset, he suggested. “Campaigns are needed to increase awareness in doctors and the public about the problem of STEMI in women,” Dr. Leurent commented. Moreover, physicians “need to be more careful in the management of STEMI in women to further reduce ischemic time. This means adopting more aggressive reperfusion strategies and treating women and men equally.

“These actions by patients and doctors will reduce the current gender gap in mortality,” he concluded.

Study Details 

Overall, 1,175 (23.5%) patients were women. They were older than the men (69 years vs. 61; P < 0.0001) and had more hypertension, but were less likely to have dyslipidemia or be current smokers.

 


Source:
Leurent G. Are there gender differences in the management of ST-elevation myocardial infarction? Data from ORBI, a prospective registry of 5,000 patients. Presented at: Acute Cardiac Care Congress; October 20, 2012; Istanbul, Turkey.

 

 

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French Registry: Women with STEMI Fare Worse Than Male Counterparts

Women are almost twice as likely as men to die in the hospital following an ST-segment elevation myocardial infarction (STEMI), according to a French registry study presented  October 20, 2012, at the Acute Cardiac Care Congress in Istanbul, Turkey.
Disclosures
  • The paper contains no information regarding conflicts of interest.

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