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A heart attack is more likely to kill a woman than a man, perhaps because women are more likely to delay seeking treatment for myocardial infarction symptoms.
Compared with men, women had a significantly higher rate of intra-hospital mortality from MI at 9% versus 4.4% (P<0.0001), according to Guillaume Leurent, MD, of the Centre Hospitalier Universitaire in Rennes, France, and colleagues.
Women also had significantly longer median delay between onset of MI symptoms and calling for medical assistance (60 versus 44 minutes, P<0.0001), reported Leurent at the Acute Cardiac Care Congress meeting in Istanbul, Turkey.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- This study compared differences in presentation and management in men versus women with ST-elevation myocardial infarction and found a number of important differences.
In addition, women had a significantly longer median delay between hospital admission and reperfusion (45 versus 40 minutes, P=0.01), and received significantly fewer recommended treatments at discharge.
Leurent noted in a statement that the results "suggest that women need to be more vigilant about chest pains and request medical help quickly to reduce ischemic time."
He also added that there may be a delay in women's response time to call for an ambulance due to a perception that MI is a "male problem."
"Doctors need to be more careful in management of STEMI in women to further reduce ischemic time," Leurent said, adding that healthcare professionals should adopt "more aggressive reperfusion strategies and [treat] women the same as men" to reduce the gender gap in MI mortality.
The researchers measured differences in management of ST-elevation MI (STEMI) by sex through a prospective registry of 5,000 STEMI patients admitted within 24 hours of symptom onset.
About one in four of the patients in the registry were women and in general they were older than men in the MI registry -- 69 versus 61. Hypertension was more common among women but women were less likely to have dyslipidemia. And men were more likely to be current smokers than women.
Mortality analyses were adjusted for sex, management, and patient characteristics, including age, hypertension, and smoking status.
Female patients also had significantly more STEMI complications than men, including atrial fibrillation (7% versus 3%, P<0.0001), and spent about a day more in the hospital than men.
Leurent and colleagues also found that women were less likely to be discharged on recommended therapies than men:
- Aspirin: 95% versus 98%, P<0.0001
- Clopidogrel/prasugrel: 93% versus 95%, P<0.0001
- Beta-blockers: 88% versus 91%, P=0.001
- ACE inhibitors: 62% versus 67%, P<0.0001
- Statins: 89% versus 95%, P<0.0001
- Cardiovascular rehabilitation: 27% versus 47%, P<0.0001
Delays in treatment have been established as associated with mortality in acute MI since the 1980s, Friederike Keating, MD, who was not involved in the study, told 麻豆传媒.
Keating, of the Fletcher Allen Health Care Medical Center in Burlington, VT., noted that these associations do not explain the difference in mortality outcomes between women and men.
"This isn't the only thing that explains the worse outcome that women have after MI, because even after adjusting for this treatment delay, the mortality difference between men and women persisted," she said.
She added that aggressive treatment is necessary from healthcare professionals to tackle the inequalities in women's outcomes and treatment regarding MI.
"The study authors point out, and I support this, that women should be treated [for MI] as aggressively as men."
From the American Heart Association:
Disclosures
The researchers declared no conflicts of interest.
Primary Source
Acute Cardiac Care Congress
Source Reference: Leurent G, et al "Are there gender differences in the management of ST-elevation myocardial infarction? Data from ORBI, a prospective registry of 5,000 patients" ACCC 2012.