Differences in management and outcomes for men and women with ST-elevation myocardial infarction

Ehsan Khan, David Brieger, John Amerena, John J. Atherton, Derek P. Chew, Ahmad Farshid, Marcus Ilton, Craig P. Juergens, Nadarajah Kangaharan, Rohan Rajaratnam, Amy Sweeny, Darren L. Walters, Clara K. Chow

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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.

LanguageEnglish
Pages118-123
Number of pages6
JournalMedical Journal of Australia
Volume209
Issue number3
DOIs
Publication statusPublished - 6 Aug 2018
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Khan, Ehsan ; Brieger, David ; Amerena, John ; Atherton, John J. ; Chew, Derek P. ; Farshid, Ahmad ; Ilton, Marcus ; Juergens, Craig P. ; Kangaharan, Nadarajah ; Rajaratnam, Rohan ; Sweeny, Amy ; Walters, Darren L. ; Chow, Clara K. / Differences in management and outcomes for men and women with ST-elevation myocardial infarction. In: Medical Journal of Australia. 2018 ; Vol. 209, No. 3. pp. 118-123.
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title = "Differences in management and outcomes for men and women with ST-elevation myocardial infarction",
abstract = "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.",
author = "Ehsan Khan and David Brieger and John Amerena and Atherton, {John J.} and Chew, {Derek P.} and Ahmad Farshid and Marcus Ilton and Juergens, {Craig P.} and Nadarajah Kangaharan and Rohan Rajaratnam and Amy Sweeny and Walters, {Darren L.} and Chow, {Clara K.}",
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Khan, E, Brieger, D, Amerena, J, Atherton, JJ, Chew, DP, Farshid, A, Ilton, M, Juergens, CP, Kangaharan, N, Rajaratnam, R, Sweeny, A, Walters, DL & Chow, CK 2018, 'Differences in management and outcomes for men and women with ST-elevation myocardial infarction', Medical Journal of Australia, vol. 209, no. 3, pp. 118-123. https://doi.org/10.5694/mja17.01109

Differences in management and outcomes for men and women with ST-elevation myocardial infarction. / Khan, Ehsan; Brieger, David; Amerena, John; Atherton, John J.; Chew, Derek P.; Farshid, Ahmad; Ilton, Marcus; Juergens, Craig P.; Kangaharan, Nadarajah; Rajaratnam, Rohan; Sweeny, Amy; Walters, Darren L.; Chow, Clara K.

In: Medical Journal of Australia, Vol. 209, No. 3, 06.08.2018, p. 118-123.

Research output: Contribution to journalArticle

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 - 2018/8/6

Y1 - 2018/8/6

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.

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