MedicalResearch.com Interview with:
Dr. Edina Cenko MD, PhD first author and
Dr. Raffaele Bugiardini M.D. FESC, FAHA, Professor of Cardiovascular Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
MedicalResearch.com: What is the background for this study?
Response: Recent studies have identified younger women as “at-higher risk of mortality” after acute myocardial infarction. However, There are few studies looking at sex differences in mortality of patients with ST-Elevation Myocardial Infarction (STEMI). None of these studies have adjusted outcomes for treatment and delay to primary PCI, which may largely contribute to variations in clinical decision making and sex differences in outcomes. We used a large data set with fully risk and medications-adjusted models to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age in this excess of risk.
MedicalResearch.com: What are the main findings?
Response: The different twist to this manuscript is to demonstrate that even when women have the same aggressive interventional and medical therapy as men, they die more than men and much more if women are younger , less than 60 years
MedicalResearch.com: What should readers take away from your report?
Response: Younger women are less likely to have a STEMI, but when they do so they show an excess of 30-day death than men, even in primary PCI treated patients. One strategy does not fit all in terms of women and men and mortality after STEMI. We need a more personalized approach to cardiovascular care. Behind sex disparities, sex is a biological variable in myocardial infarction.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The study supports the new NIH initiative requiring researchers to factor sex into the design, analysis, and reporting of studies. Severe adverse effects in women were not recognized by clinical trials as there was not a sufficient sample of women. Studying (balancing or randomizing) both sexes may inform appropriate medical care for women.
MedicalResearch.com: Is there anything else you would like to add?
Response: The current study is the first investigation which demonstrates that differences between younger men and younger women in STEMI mortality rates are unrelated to disparities in treatment. This holds true even in patients undergoing primary PCI. However, more studies are needed. Findings from men could not necessarily be applied to women. It is central considering the effects of sex as a biological variable at all stages and in any type of research on ischemic heart disease.
Any disclosures? Nothing to disclose
Cenko E, Yoon J, Kedev S, et al. Sex Differences in Outcomes After STEMIEffect Modification by Treatment Strategy and Age. JAMA Intern Med. Published online April 09, 2018. doi:10.1001/jamainternmed.2018.0514
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