Factors associated with worse outcomes in patients with acute ST segment elevation myocardial infarction: experience in sex differences from the Croatian Branch of the ISACS-CT Registry

    Authors

    Keywords

    acute coronary syndrome, ISACS-CT, gender differences, ST segment elevation acute myocardial infarction

    DOI

    https://doi.org/10.15836/ccar2017.392

    Full Text

    Background : Women have poorer outcomes in acute coronary syndrome (ACS) due to older age, comorbidities, atypical presentation and delay in admission. ( 1 ) The aim is to consider gender differences in outcomes in the Croatian Branch of the ISACS-CT registry. Methods : From January 2012 to February 2017, 1808 patients were enrolled in the Croatian branch of the registry, 46% (n=844) presenting with acute ST segment elevation acute myocardial infarction (STEMI), 35% (n=637) with non-ST segment elevation myocardial infarction (NSTEMI) and 18% (n=327) with unstable angina. Sex ratio, male to female, was 2.2:1, the median age 65 (57-75) years. In-hospital mortality was defined as the primary outcome. Results : There was no sex difference in type of ACS at admission. Women were significantly older, generally more burdened with comorbidities and arrived to the hospital with more delay from symptom onset (women vs. men: in the first 2 h - 19% vs. 24%, p=0.02; in the first 6 h - 49% vs. 58%, p<0.01). In patients with STEMI, logistic analysis showed female sex (OR = 2.9, CI 95% 1.1-8.1., p=0.04), diabetes (OR=2.7), creatinine levels (OR=1.01) and time from onset to admission (OR=0.65), as independent factors associated with in-hospital mortality ( Figure 1 ). Considering time from symptom onset to admission, worse outcomes in women were visible only in the 2-6 hour window (women vs. men: 15.3% vs. 2.5%, p>0.01) ( Figure 2 ). There was no gender difference in undergoing percutaneous coronary intervention (PCI), but successful revascularization was less often achieved in women (92% vs. 97%, p<0.01). Moreover, female sex (OR = 4.7, CI 95% 1.5-14.7, p=0.021), together with creatinine levels (OR=1.01) and GB IIB/IIIA administration (OR=2.7), proved independently associated with in-hospital mortality in the PCI group, whereas this effect was not seen in the non-invasive treatment group. Sex differences in in-hospital mortality.
STEMI = ST segment elevation acute myocardial infarction, NSTEMI = non-ST segment elevation myocardial infarction, PCI = percutaneous coronary intervention Sex differences in in-hospital mortality in patients with acute ST segment elevation myocardial infarction depending on time from onset of symptoms to admission.
STEMI = ST segment elevation acute myocardial infarction Conclusion : Gender differences in patients presenting with STEMI are visible in the Croatian branch of the ISACS-CT registry. In this setting, female sex bears risk of worse outcome associated with delay in admission and invasive treatment.

    Cardiologia Croatica
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    Factors associated with worse outcomes in patients with acute ST segment elevation myocardial infarction: experience in sex differences from the Croatian Branch of the ISACS-CT Registry

    Extended Abstract
    Issue9-10
    Published
    Pages392-393
    PDF via DOIhttps://doi.org/10.15836/ccar2017.392
    acute coronary syndrome
    ISACS-CT
    gender differences
    ST segment elevation acute myocardial infarction

    Authors

    Filip Lončarić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora FabijanovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Nina JakušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Petra MjehovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dorja SabljakORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Antonija MiškovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dominik OrozORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Background : Women have poorer outcomes in acute coronary syndrome (ACS) due to older age, comorbidities, atypical presentation and delay in admission. ( 1 ) The aim is to consider gender differences in outcomes in the Croatian Branch of the ISACS-CT registry. Methods : From January 2012 to February 2017, 1808 patients were enrolled in the Croatian branch of the registry, 46% (n=844) presenting with acute ST segment elevation acute myocardial infarction (STEMI), 35% (n=637) with non-ST segment elevation myocardial infarction (NSTEMI) and 18% (n=327) with unstable angina. Sex ratio, male to female, was 2.2:1, the median age 65 (57-75) years. In-hospital mortality was defined as the primary outcome. Results : There was no sex difference in type of ACS at admission. Women were significantly older, generally more burdened with comorbidities and arrived to the hospital with more delay from symptom onset (women vs. men: in the first 2 h - 19% vs. 24%, p=0.02; in the first 6 h - 49% vs. 58%, p<0.01). In patients with STEMI, logistic analysis showed female sex (OR = 2.9, CI 95% 1.1-8.1., p=0.04), diabetes (OR=2.7), creatinine levels (OR=1.01) and time from onset to admission (OR=0.65), as independent factors associated with in-hospital mortality ( Figure 1 ). Considering time from symptom onset to admission, worse outcomes in women were visible only in the 2-6 hour window (women vs. men: 15.3% vs. 2.5%, p>0.01) ( Figure 2 ). There was no gender difference in undergoing percutaneous coronary intervention (PCI), but successful revascularization was less often achieved in women (92% vs. 97%, p<0.01). Moreover, female sex (OR = 4.7, CI 95% 1.5-14.7, p=0.021), together with creatinine levels (OR=1.01) and GB IIB/IIIA administration (OR=2.7), proved independently associated with in-hospital mortality in the PCI group, whereas this effect was not seen in the non-invasive treatment group. Sex differences in in-hospital mortality.
STEMI = ST segment elevation acute myocardial infarction, NSTEMI = non-ST segment elevation myocardial infarction, PCI = percutaneous coronary intervention Sex differences in in-hospital mortality in patients with acute ST segment elevation myocardial infarction depending on time from onset of symptoms to admission.
STEMI = ST segment elevation acute myocardial infarction Conclusion : Gender differences in patients presenting with STEMI are visible in the Croatian branch of the ISACS-CT registry. In this setting, female sex bears risk of worse outcome associated with delay in admission and invasive treatment.