MI: Gender Differences Remain in Presentation, Treatment and Outcomes

Luke Kim, M.D., FACC, FSCAI Assistant Professor of Medicine Interventional Cardiac and Endovascular Laboratory  Greenberg Division of Cardiology, Department of Medicine Weill Cornell Medical College/The New York Presbyterian HospitalMedicalResearch.com Interview with:
Luke Kim, M.D., FACC, FSCAI
Assistant Professor of Medicine
Interventional Cardiac and Endovascular Laboratory
Greenberg Division of Cardiology, Department of Medicine
Weill Cornell Medical College/The New York Presbyterian Hospital

MedicalResearch: What are the main findings of this study?

Dr. Kim: The main findings of the study include:

  1. From 2007-2011, there was no significant change in the rate of acute MI in both male and female cohorts in U.S. . Although there was a decline in the rate of ST-elevation (STEMI) in those ≥55 years old, the rate remains steady in patients < 55 years old, especially in the female cohort after 2009.
  2. Female patients <55 years old with MI were sicker at baseline than the male counterparts with more likelihood of having diabetes, hypertension, chronic renal insufficiency, peripheral vascular disease, congestive heart failure and obesity.
  3. Female patients were more likely to present with non– STEMI vs. STEMI and more likely to develop shock complicating their MIs.
  4. Female patients are less likely to undergo coronary artery revascularization including percutaneous coronary intervention and coronary artery bypass surgery.
  5. Unadjusted risk of death was higher in female vs male (5.2% vs. 3.7%, p<0.001) along with higher incidence of stroke (0.5% vs. 0.3%, p<0.001), bleeding (4.9% vs. 3.0%, p<0.001), vascular complication (0.6% vs. 0.4%, p<0.001) and ARF (11.6% vs. 9.6%, p<0.001). After adjustment, death (OR 1.10 CI 1.04-1.17), stroke (OR 1.31 CI 1.10-1.55), bleeding (OR 1.30 CI 1.22-1.37), and vascular complications (OR 1.33 CI 1.15-1.55) were all significantly higher for female cohort.

MedicalResearch: Were any of the findings unexpected?

Dr. Kim: 

  1. It was unexpected that there is still a gender discrepancy in terms of likelihood of undergoing coronary artery revascularization.
  2. Furthermore, female gender appears to be a predictor of worse outcome after revascularization.

MedicalResearch: What should patients and clinicians take away from this report?

Dr. Kim:

  1. Younger female patients with coronary artery disease remain a potentially undertreated population in terms of prevention and treatment when they present with acute coronary syndrome.
  2. We need to do a better job of identifying patients at risk, especially in this cohort to prevent coronary artery disease early.
  3. Future studies will have to done in order to identify why this cohort has worse outcome after coronary artery revascularization.

Citation:

The Society for Cardiovascular Angiography and Interventions
Poster Session A/Wednesday, May 28, 2014

Trends in Myocardial Infarction and In-Hospital Outcomes in Women <55 Years Old in the United States, 2007-2011

Authors: Luke Kim, New York Presbyterian Hospital, Cornell Campus, United States; Dmitriy Feldman, New York Presbyterian Hospital, Cornell Campus, United States; Rajesh Swaminathan, New York Presbyterian Hospital, Cornell Campus, United States; Robert Minutello, New York Presbyterian Hospital, Cornell Campus, United States; Robert Minutello, New York Presbyterian Hospital, Cornell Campus, United States; Geoffrey Bergman, New York Presbyterian Hospital, Cornell Campus, United States; Harsimran Singh, New York Presbyterian Hospital, Cornell Campus, United States; David Yang, New York Presbyterian Hospital, Cornell Campus, United States; Konstantinos Charitakis, New York Presbyterian Hospital, Cornell Campus, United States; Ashish Shah, New York Presbyterian Hospital, Cornell Campus, United States; Shing Chiu Wong, New York Presbyterian Hospital, Cornell Campus, United States

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