Acute Myocardial Infarction In Women Research Articles

Prognostic impact of high-intensity lipid-lowering therapy under-prescription after acute myocardial infarction in women.

Women are less likely to receive lipid-lowering therapy (LLT) after acute myocardial infarction (AMI). We analysed whether this under-prescription currently persists and has an impact on long-term outcomes. The FAST-MI programme consists of nationwide registries including all patients admitted for AMI ≤ 48 h from onset over a 1 month period in 2005, 2010, and 2015, with long-term follow-up. This analysis focused on high-intensity LLT (atorvastatin ≥ 40 mg or equivalent, or any combination of statin and ezetimibe) in women and men. Women accounted for 28% (N = 3547) of the 12 659 patients. At discharge, high-intensity LLT was significantly less prescribed in women [54 vs. 68% in men, P < 0.001, adjusted odds ratio (OR) 0.78(95% confidence interval (CI) 0.71-0.87)], a trend that did not improve over time: 2005, 25 vs. 35% (P = 0.14); 2010, 66 vs. 79% (P < 0.001); 2015, 67 vs. 79.5% (P = 0.001). In contrast, female sex was not associated with a lack of other recommended treatments at discharge: beta-blockers [adjusted OR 0.98(95% CI 0.88-1.10), P = 0.78], or renin-angiotensin blockers [adjusted OR 0.94(95% CI 0.85-1.03), P = 0.18]. High-intensity LLT at discharge was significantly associated with improved 5 year survival and infarct- and stroke-free survival in women [adjusted hazard ratios (HR) 0.74(95% CI 0.64-0.86), P < 0.001 and adjusted HR: 0.81(95% CI: 0.74-0.89); P < 0.001, respectively]. Similar results were found using a propensity score-matched analysis [HR for 5 year survival in women with high-intensity LLT: 0.82(95% CI 0.70-0.98), P = 0.03]. Women suffer from a bias regarding the prescription of high-intensity LLT after AMI, which did not attenuate between 2005 and 2015, with potential consequences on both survival and risk of cardiovascular events.

Women Acute Myocardial Infarction-Identifying and Understanding the Gender Gap (WAMy-GAP): A Study Protocol.

Barriers to accessing care and misinterpretations of ischemic heart disease symptoms due to lack of awareness contribute to women's delay in seeking care. Women may delay seeking treatment for up to 3 h or even up to 5 days. They often perceive themselves to be at low risk of cardiovascular disease (CVD) and prioritize family responsibilities or household chores. The causes of this delay are multifactorial and influence the decision-making process, particularly in the pre-hospital phase. The objective of this study protocol is to evaluate prodromal symptoms and identify risk behaviors in women with acute myocardial infarction (AMI). This is a protocol for a multicenter study that will be conducted using the mixed-method methodology using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) to evaluate symptoms and semi-structured interviews to investigate behaviors. This study protocol is intended to fill an important knowledge gap on premonitory and acute symptoms of AMI in women in Italy, as well as to understand the causes and mechanisms underlying delays in accessing healthcare services during an acute event such as AMI. The investigation of this issue will facilitate the removal of gender-related inequalities in the diagnosis and treatment of acute myocardial infarction while also fostering dialogue on the barriers to behavior change.

Acute Myocardial Infarction in Women, a Study on Risk Factors, Angiographic Features and Outcomes.

Women with acute coronary syndrome are more likely to have cardiovascular disease risk factors and atypical symptoms as compared to men. In Nepal, there is a rising trend of Coronary Artery Disease and myocardial infarction in women. However, research on acute myocardial infarction in women is lacking. The aim of this study was to study the cardiac risk factors, clinical features, angiographic features, and outcome of acute myocardial infarction in Nepalese women admitted to Hospital. This was a cross sectional study done at Shahid Gangalal National Heart Center Kathmandu from September 2016 to March 2017. Female patients admitted with a diagnosis of acute ST-segment elevation myocardial infarction or non-ST segment elevation myocardial infarction, who fulfilled the inclusion criteria were included in the study. The details of the patients, demographic profile, major clinical symptoms, major coronary artery disease risk factors, angiographic features and outcomes were recorded and assessed during the study period. Coronary angiography was done in 112 patients out of 178 patients. Out of 178 patients, 85.95 % had ST-segment elevation myocardial infarction and 14.05% had non-ST segment elevation myocardial infarction. The mean patient age was 62.53 ± 12.1. 26.4% patients were of age less than 55 years. Major risk factors were central obesity (94.61%), dyslipidemia due to low HDL (78.65%). hypertension (54.49%), smoking (54.49%) and type 2 diabetes (34.83%). The most common atypical symptoms were shortness of breath (35.39 %,) , nausea and vomiting (23. 6%) and epigastric pain (6.74%), Single vessel disease was found in 36%; double vessel disease in 26.3% and triple vessel disease in 28.9% of patients. The primary outcome of in- hospital mortality was 3.37 %. Our study showed that significant number of females had Coronary Artery Disease at early age. Among women with myocardial infarction in Nepal, obesity due to high waist to hip ratio was the most common risk factor followed by dyslipidemia due to low high density lipoproteins, smoking, hypertension, and diabetes. Atypical symptoms were also common findings. Single vessel disease was the most common lesion and left anterior descending artery was the most commonly involved vessel. Mortality was seen in ST-segment elevation myocardial infarction patients only.

A randomized clinical trial of sex and population-specific troponin cutoffs for ruling out acute MI - the danish study of sex and population-specific cutoffs of troponin (DANSPOT)

Abstract Background Measurements of high-sensitivity cardiac troponin (cTn) T/I are used as the gold standard and are the preferred biomarkers to diagnose acute myocardial infarction (MI) in conjugation with symptoms and changes in the ECG. The URL is based on the 99th percentile of troponin concentrations in a healthy reference population. Currently, a sex-uniform manufacturer provided 99th percentile URL of troponin is utilized at Danish hospitals as a diagnostic cutoff for acute MI for both men and women. Reportedly, healthy men have twofold the troponin level compared to healthy women, suggesting that the use of a uniform URL for troponins may lead to the under-diagnostication of acute MI in women and potentially over-diagnostication in men. Purpose The purpose of the DANSPOT study is to evaluate the clinical effect on diagnosis, treatment and outcomes in men and women presenting with acute MI of implementing international guidelines recommended sex-specific 99th percentile URLs for troponin into clinical practice. Methods First, to determine the sex-specific 99th percentile URLs of troponins (table) based on a healthy Danish reference population, blood samples from Danish blood donors, were analyzed using five high-sensitivity (hs) cTn assays (Siemens Atellica and Vista hs-cTnI, Roche hs-cTnT, Abbott Alinity hs-cTnI and Orthos VITROS hs-cTnI). Second, the DANSPOT study is a nationwide cluster-randomized trial with "stepped-wedge" design (figure) with participation of 22 Danish hospital center. With one-month intervals, each of the 22 centers have been randomized to shift from the presently applied sex-uniform 99th percentile URL of troponin to the population and sex-specific 99th percentiles URLs. First center started implementing the new 99th percentiles URLs on April 1, 2022, and the last center is planned to enroll on January 1, 2024. Patients are followed up in Danish registries for 12 months after index admission. The primary endpoint is a composite of myocardial infarction, unplanned revascularization (after index admission) and all-cause mortality and is calculated for the cohort of women and men with ≥2 measurements of troponin within the first 24 hours of admission with maximal troponin level between the new sex-specific 99th percentile URLs and the old sex-uniform 99th percentile URL. Perspective The clinical significance of sex-specific 99th percentile URLs of troponin is poorly investigated and for the same reason not yet implemented in Denmark or many other countries. With the implementation of population and sex-specific 99th URLs of troponin, we expect to detect significantly more women with acute MI, theoretically resulting in a more accurate diagnosis and treatment of women and men with acute MI. This would be guideline-defining for implementing sex-specific cutoffs for troponin in Denmark as well as internationally as recommended in guidelines by professional cardiological societies.Schematic presentation of study designTable of the new 99th percentiles of cTn

Acute coronary syndrome in women. Are there any special features?

Introduction. The increasing incidence of coronary heart disease, including acute coronary syndrome, among women, the lack of public awareness of the cardiovascular risks in women and the late presentation of these patients for medical care necessitates a review of the existing literature on the problem.Purpose of the work was to systematize data on acute coronary syndrome in women and to characterize its distinctive features.Materials and methods. A literature search was conducted for the period from 2011 to 2022 in PubMed, Cochrane Library, Embase, Google Scholar using the search terms: cardiovascular diseases in women, ischemic heart disease in women, acute coronary syndrome in women and acute myocardial infarction in women. Inclusion criteria: evidence of sex differences in acute coronary syndrome. The preferred languages were Russian and English.Results and discussion. The risk factors of acute coronary syndrome in women are characterized and the data on the peculiarities of the clinic of this pathology are summarized. Data on the problem of a differentiated approach and on the determination of management tactics for patients with acute coronary syndrome are presented.Conclusion. Despite the increasing awareness of cardiovascular disease as a major cause of disability and mortality in both sexes, the attention of specialists to the problem of a differentiated approach to the management of women with ACS remains insufficient, which determines the need for in-depth research on this problem.

Abstract P3105: Stress Exacerbates Ischemia/reperfusion Injury In The Female Heart Through The Glucocorticoid Receptor Signaling In Cardiomyocytes

It is estimated that over 30,000 women younger than 55-years-old die of acute myocardial infarction (AMI) in the United States annually. Clinical data suggest that exposure to mental stress exacerbates the outcomes of an AMI in women. However, a knowledge gap exists regarding the molecular mechanisms whereby stress contributes to AMI in women and how they differ in men. The present project aims to define the mechanisms underlying the link between stress, glucocorticoids (stress hormones), the glucocorticoid receptor (GR) signaling, and the worse outcomes of AMI in females than in their male counterparts. We challenged male and female transgenic mice lacking GR in cardiomyocytes (cardioGRKO) and their respective wild-type controls in a murine model of "mental" stress followed by ischemia/reperfusion (AMI) injury. Our data show that stress exacerbated the response to AMI injury in control females compared to their male counterparts. Females without cardiomyocyte GR were protected and presented significantly reduced infarct areas compared to cardioGRKO males and control males and females with intact GR signaling. These results demonstrated that stress directly affected the heart and that these effects are sexually dimorphic. The severity of the infarct and cardiomyocyte death was further exacerbated during the highest estrogen activity phase (proestrus) of the female cycle. Our in vitro studies additionally supported these data, showing that glucocorticoids block estrogen's pro-survival effects on cardiomyocytes in hypoxia/re-oxygenation conditions in a mechanism dependent upon GR inhibition of estrogen regulation of antioxidant pathways, including decreased levels of the master regulator of the antioxidant response, nuclear factor-erythroid factor 2-related factor 2 (Nrf2), and increased superoxide and lipid peroxides production. Our in vivo models displayed similar findings. Our study is the first to test the impact of mental stress on activating glucocorticoid signaling in the heart in the setting of AMI. This study is relevant to human health as a proof of concept that exposure to high stress levels aggravates AMI in premenopausal hearts by cardiomyocyte GR-regulated mechanisms that may be targeted to develop therapies tailored to women.

Spontaneous coronary artery dissection in women with acute myocardial infarction: is there a new role for autoimmunity?

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction in women and has an unclear pathophysiology. Autoantibodies (AAs) targeting angiotensin-II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) have known detrimental effects on endothelial function. We investigated the prevalence of these AAs in SCAD-affected female patients. Female patients diagnosed at coronary angiography with myocardial infarction and SCAD were consecutively enrolled. Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA titres and seropositivity prevalence were compared between SCAD patients, ST-elevation myocardial infarction (STEMI) patients, and healthy women. Ten women with SCAD and 20 age-matched controls (10 women with STEMI and 10 healthy women) were included. Six out of 10 (60%) women with myocardial infarction and SCAD were seropositive for AT1R-AAs and ETAR-AAs. In contrast, only one (10%) healthy woman and one (10%) STEMI patient were seropositive for AT1R-AAs (P = 0.03 and P = 0.03, respectively). One STEMI patient was seropositive for ETAR-AAs, while none of the healthy women was found to be seropositive (P = 0.03 and P = 0.01, respectively). The median AA titre was significantly higher in SCAD patients than in healthy women (P = 0.01 for AT1R-AAs; P = 0.02 for ETAR-AAs) and STEMI patients (P < 0.001 for AT1R-AAs; P = 0.002 for ETAR-AAs). Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA seropositivity is significantly higher in SCAD women with myocardial infarction than in healthy women or female patients with STEMI. Our findings, corroborated by previous data in the literature and biological plausibility, suggest a possible role for AT1R-AAs and ETAR-AAs in the pathophysiology of SCAD in women with acute myocardial infarction and should warrant further studies with larger sample sizes.

A bibliometric analysis of acute myocardial infarction in women from 2000 to 2022.

Plenty of publications had been written in the last several decades on acute myocardial infarction (AMI) in women. However, there are few bibliometric analyses in such field. In order to solve this problem, we attempted to examine the knowledge structure and development of research about AMI in women based on analysis of related publications. The Web of Science Core Collection was used to extract all publications regarding AMI in women, ranging from January 2000 to August 2022. Bibliometric analysis was performed using VOSviewer, Cite Space, and an online bibliometric analysis platform. A total of 14,853 publications related to AMI in women were identified from 2000 to 2022. Over the past 20 years, the United States had published the most articles in international research and participated in international cooperation the most frequently. The primary research institutions were Harvard University and University of Toronto. Circulation was the most cited journal and had an incontrovertible academic impact. 67,848 authors were identified, among which Harlan M Krumholz had the most significant number of articles and Thygesen K was co-cited most often. And the most common keywords included risk factors, disease, prognosis, mortality, criteria and algorithm. The research hotspots and trends of AMI in women were identified and explored using bibliometric and visual methods. Researches about AMI in women are flourishing. Criteria and algorithms might be the focus of research in the near future, which deserved great attentions.

Ventricular fibrillation complicating acute myocardial infarction in women

Abstract Background Very little data is available in women presenting with ventricular fibrillation in the setting of acute myocardial infarction. Purpose To investigate sex-discrepancies in the incidence, characteristics and outcomes of acute myocardial infarction complicated by ventricular fibrillation. Methods Data were analyzed from the FAST-MI registry, which prospectively included 14,406 patients with acute myocardial infarction (mean age 66±14 years, 72% male, mean left ventricular ejection fraction 52±12%, 59% with ST elevation myocardial infarction). All consecutive patients admitted to French cardiac intensive care units ≤48 hours from acute myocardial infarction onset during a 1-month period every five years during 1995 and 2015 were included. This analysis focused on ventricular fibrillation occurring during the initial in-hospital stay for acute myocardial infarction in women compared to men. Results A total of 359 patients developed ventricular fibrillation during acute myocardial infarction, including 81 women (2.0% of 4,091 women overall) and 278 men (2.7% of 10,315) (p=0.02). ST-elevation myocardial infarction (OR 2.29, 95% CI 1.75–2.99, p&amp;lt;0.001) was independently associated with occurrence of ventricular fibrillation, while female gender (OR 0.73, 95% CI 0.56–0.95, p=0.02), hypertension (OR 0.75, 95% CI 0.60–0.94, p=0.01) and prior MI (OR 0.69, 95% CI 0.50–0.96, p=0.03) were protective factors. Women were less likely to have percutaneous coronary intervention during hospitalization than men (48.1% vs. 69.1%, OR 0.48, 95% CI 0.29–0.80, p&amp;lt;0.001). One-year mortality was higher in women compared to men (23.1% vs. 7.0%, HR 5.5, 95% CI 1.7–17.2, p=0.001). However, after adjustment for age, type of myocardial infarction and percutaneous coronary intervention, female gender was no longer associated with a worse one-year mortality (adjusted HR 1.04, 95% CI 0.71–1.51, p=0.85). Conclusion and relevance Women have lower risk of developing ventricular fibrillation during acute myocardial infarction compared to men. However, they are less likely to receive early coronary interventions than men, possibly contributing to worse outcomes. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): French Society of Cardiology

Incidence, Characteristics, and Outcomes of Ventricular Fibrillation Complicating Acute Myocardial Infarction in Women Admitted Alive in the Hospital.

BackgroundLittle data are available in women presenting with ventricular fibrillation (VF) in the setting of acute myocardial infarction (AMI). We assessed frequency, predictors of VF, and outcomes, with a special focus on women compared with men.Methods and ResultsData were analyzed from the FAST‐MI (French Registry of Acute ST‐Elevation or Non‐ST‐Elevation Myocardial Infarction) program, which prospectively included 14 406 patients admitted to French cardiac intensive care units ≤48 hours from AMI onset between 1995 and 2015 (mean age, 66±14 years; 72% men; mean left ventricular ejection fraction, 52±12%; 59% with ST‐segment–elevation myocardial infarction). A total of 359 patients developed VF during AMI, including 81 women (2.0% of 4091 women) and 278 men (2.7% of 10 315 men, P=0.02). ST‐segment–elevation myocardial infarction (odds ratio [OR], 2.29 [95% CI, 1.75–2.99]; P<0.001) was independently associated with the onset of VF during AMI. In contrast, female sex (OR, 0.73 [95% CI, 0.56–0.95]; P=0.02), hypertension (OR, 0.75 [95% CI, 0.60–0.94]; P=0.01), and prior myocardial infarction (OR, 0.69 [95% CI, 0.50–0.96]; P=0.03) were protective factors. Women were less likely to have cardiac intervention than men (percutaneous coronary intervention during hospitalization 48.1% versus 66.9%, respectively; P=0.04) with a higher 1‐year mortality in women compared with men (50.6% versus 37.4%, respectively; P=0.03), including increased in‐hospital mortality (42.0% versus 32.7%, respectively; P=0.12). After adjustment, female sex was no longer associated with a worse 1‐year mortality (adjusted hazard ratio, 1.10 [95% CI, 0.75–1.61]; P=0.63).ConclusionsWomen have lower risk of developing VF during AMI compared with men. However, they are less likely to receive cardiac interventions than men, possibly contributing to missed opportunities of improved outcomes.

CHEST PAIN IN WOMEN. IS IT ALWAYS ATHEROSCLEROTIC?

Patients both male and female with diagnosis of Acute Coronary Syndrome (ACS) present with chest pain as presenting complaint. Lichtman JH et al. in his study with ACS showed that 93% of women presented with chest pain or discomfort.1 As compared to men women experience more associated symptoms as primary complaint. The associated symptoms are fatigue, dyspnea, backache, flue like symptoms, indigestion, palpitations and most common is anxiety &amp; feeling scarry.2 Keeping these scenarios in mind one should inquire this associated presentation along with chest pain or discomfort in evaluating ACS in women. In continuation with symptoms there is quite a debate on pathophysiology of Acute Myocardial infraction in men and women regarding coronary pathologic features.3 Type 1 plaque rupture most common in both genders with plaque erosion most common in women in non-obstructive coronary artery disease.4 Spontaneous coronary artery dissection (SCAD) having high mortality exists in the absence of risk factor of ACS.5 It was found in women up to 35% of patients with mean age of 42 to 53 years with a MACE (Major acute coronary event) of 47.4% and 10 years mortality rate of 7.7%2 SCAD seen in peripartum cases, oral contraception use, lack of exercise, connective tissue disorders and vasculidites. It is important for the physician to have in mind these disorders to avoid complications of coronary interventions. In a scientific statement from AHA, Mehte LS et al. showed a lower prevalence of atheroscrotic CAD in women.3 These are certain scoring system,6 that under present women because of vague symptoms and presentation. These scoring systems lead to decrease hospital admission and less noninvasive cardiac testing. For risk satisfaction of chest pain female gender should not be taken as sole criteria for presence or absence of coronary events in presence of other multiple factors. The last but not the least is the psychosocial stress more in women than in men. It has been found that young women who present with early onset myocardial infarction have more psychosocial risk factors in comparison to men of similar age,3 probably having high rates of poverty and trauma exposure during childhood because of various reasons.7 Different studies are endorsing relationship between depression and ischemic heart disease as prognostic factor after ACS.7 In our population where there is lack of education, poverty, awareness of disease especially in women the physician should ponder on different factors mentioned above i.e. presentation perceptions, prevalence, pathophysiology and psychosocial stress for evaluation and management of chest pain.

Abstract 9541: Sex Disparities in In-Hospital Outcomes of Left Ventricular Aneurysm Complicating Acute Myocardial Infarction: A United States Nationwide Analysis

Background: Previous studies have reported sex-specific differences in the presentation, mechanisms, and outcomes of acute myocardial infarction (AMI). Objective: To assess differences in the incidence and in-hospital outcomes of left ventricular (LV) aneurysm complicating AMI in women and men. Methods: We used the National Inpatient Sample database (NIS) from 2000 to 2017, to identify adult hospitalizations with a primary diagnosis of AMI and concomitant LV aneurysm. Incidence and trends in in-hospital mortality, complications, length of stay and costs were analyzed in women and men. Results: A total of 16,334 AMI hospitalizations with LV aneurysm were identified including 6,994 (42.8%) women and 9,340 (57.2%) men. Women had a higher incidence of LV aneurysm compared to men (0.16% vs. 0.14%; p&lt;0.001). Compared to men, women were older (73 [63-81] vs 65 [56-75]; p&lt;0.001), black race (9.6% vs 7.4%; p=0.1), and have higher elixhauser comorbidity index (2 [-1 to 9] vs 0 [-1 to 8]; p=0.014). Unadjusted in-hospital mortality was higher in women than men (12.7% vs. 7.2%; p&lt;0.001). After adjusting for demographic and baseline characteristics and excluding inter-hospital transfers, women with AMI complicated by LV aneurysm had 49% greater odds of in-hospital mortality than men (aOR 1.49, 95% Confidence Interval 1.06-2.10, p=0.02). Women with LV aneurysm were less likely than men to undergo percutaneous coronary intervention (28.5% vs. 35.4%; p&lt;0.001), bypass surgery (15.8% vs. 25.1%; p&lt;0.001), coronary atherectomy (0.8% vs. 1.9%; p=0.009) and LV aneurysm surgery (7.8% vs. 11.1%; p=0.001). Conclusions: In this large population-based cohort study, women had a slightly higher incidence but dramatically higher in-hospital mortality associated with LV aneurysm complicating AMI compared to men. Further research is necessary to validate strategies to ensure that women receive guideline-directed therapy for AMI and LV aneurysm to address the sex disparity in mortality.

Metabolic Syndrome and Myocardial Infarction in Women.

Metabolic syndrome (MetS) represents a cluster of metabolic disorders that arise from insulin resistance (IR) and adipose tissue dysfunction. As a consequence, there is an increased risk for type 2 diabetes mellitus and atherosclerotic cardiovascular disease (CVD). MetS is associated with a 2-fold increase in cardiovascular outcomes. Earlier population analyses showed a lower prevalence of MetS in women (23.9%) in comparison to men (27.8%), while later analyses suggest significantly reduced difference due to an increase in the prevalence in women aged between 20 and 39. However, the prevalence of MetS in specific populations of women, such as in women with polycystic ovary syndrome, ranges from 16% to almost 50% in some geographical regions. Abdominal fat accumulation and IR syndrome are recognized as the most important factors in the pathogenesis of MetS. After menopause, a decline in insulin sensitivity corresponds to an increase in fat mass, circulating fatty acids, low-density lipoproteins, and triglycerides. Prevalence of MetS in acute coronary syndrome (ACS) is significantly more present in women (55.9%-66.3%) than in men (40.2%-47.3%) in different cohorts. Younger women with ACS had a higher mortality rate than younger men. Acute myocardial infarction (AMI) remains a leading cause of death in aging women. Women with AMI had significantly higher rates of prior congestive heart failure, hypertension history, and diabetes. The role of androgens in CVD pathogenesis in women has not yet been clarified. The current review aims to provide an insight into the role of MetS components and inflammation for the development of atherosclerosis, CVD, and AMI in women.

STUDY OF RISK FACTORS AND CLINICAL PROFILE OF ACUTE MYOCARDIAL INFARCTION IN FEMALES

Cardiovascular disease is the most important health issue facing mankind and continues to be major cause of morbidity and mortality.Women are disproportionately affected by coronary artery disease(CAD) compared with men.There are different clinical presentations of heart disease and acute myocardial infarction in women than in men.Also different studies shows that there is difference in the major cardiovascular risk factors amongst men and women at younger age.The present study was undertaken with a view to understand the clinical prole of acute myocardial infarction in women and observe the variations in acute myocardial infarction between men and women. Materials and methods-This observational and analytical study includes 118 female cases of acute myocardial infarction admitted to ICCU and randomly selected 118 male cases of acute myocardial infarction admitted to ICCU during the same tenure.Various necessary th investigations were carried out and risk factors of acute myocardial infarction were determined.All the cases were followed up on the 7 day of admission and one month after discharge from the hospital for various complications.Data thus collected was analysed at the end of study. Results-Maximum number of female cases were in age group 60-69 years(45.6%)while maximum number of male cases were in age group 50- 59 years(33.05%).Anterior wall myocardial infarction was the commonest type of acute myocardial infarction in both groups.ST elevation myocardial infarction was more common in males(94.9%)as compared to females(83.89%) whereas non ST elevation myocardial infarction was common in females(10%) as compared to males (5%).Atypical chest pain was more common in female cases(50.8%)whereas typical chest pain was more common with male cases(52.4%).Also dyspnoea as presenting symptom was signicantly more in female cases(51.6%)as compared to male cases(20.3%).Among the risk factors as Diabetes mellitus,signicant difference was observed in female(45.7%) vs male cases(30.5%).Other risk factors like lack of physical activity was signicantly more in female cases(84.7%) as compared to male cases(50%).Central obesity and family history of CAD were more common in female cases . 42(35.6%) female cases had arrthymias during hospital stay as compared to 50(42.4%) male cases.Post MI angina was present in 21 (20.38%) female cases and 12(11.11%) male cases during one month follow up.Mortality was more common in female cases(12.7%) compared with the male cases(8.47%)but it was not statistically signicant. Females suffer from coronary artery disease slightly at older age Conclusions- as compared to males.Atypical chest pain and dyspnoea are more common presenting symptoms in females compared to males.Diabetes mellitus,central obesity, lack of physical activity and family history of CAD are most common risk factors in female cases for acute myocardial infarction.ST elevation myocardial infarction is less common in females as compared to males.Complications like congestive cardiac failure ,arrthymias are more common in females as compared to males.The overall mortality with acute myocardial infarction are common in females than males.

Clinical profile and angiographic outcomes of acute myocardial infarction in women treated by primary percutaneous coronary intervention

Coronary heart disease has been mainly considered as men disease. However, it is the leading cause of morbidity and mortality in women worldwide. We aimed to determine the clinical profile and angiographic outcomes in women following primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). We included 352 patients admitted for STEMI and managed with PCI. They were enrolled between January 2000 and march 2017 in Cardiology B department of Fattouma Bourguiba university hospital. Among 352 patients, 56 were women (15.9%). They were older than men. Mean age was 66.5 ± 10 years versus 58 ± 11 years. Females had higher incidence of hypertension (55.4% vs. 24.7%; P < 0.001), diabetes (44.6% vs. 30.4%; P = 0.037), and dyslipidemia (12.5% vs. 10.8%; P = 0.012). Smoking and history of coronary disease were more prevalent in men ( P < 0.001 and P = 0.024 respectively). Women had longer door to balloon time ( P = 0.004). Anterior wall myocardial infarction was more represented in women population (62.5% vs. 47.3%; P = 0.020), but no significant difference was observed in the incidence of initial or post procedural cardiogenic shock. Women were more likely to have multivessel disease (17.9% vs. 10.8%; P = 0.01), initial reduced TIMI flow (78.6% vs. 70.3%; P = 0.04), no reflow (21.4% vs. 11%; P = 0.033) and per procedural coronary dissection (12.5% vs. 6.8%; P = 0.013). In hospital mortality rate was higher in female population (23.2% vs. 9.8%; P = 0.005). In multivariate analysis, female sex was not an independent factor of in hospital death. STEMI in women remains a serious pathology. Its particularities must be better known and studied in order to optimize management and prognosis.

Особенности неблагоприятного течения и летальность при остром инфаркте миокарда у женщин и мужчин

The cause of mortality in the Russian Federation in half of cases is still cardiovascular diseases (CVD), the most prognostically unfavorable variant of which is certainly acute myocardial infarction (AMI). At the same time, there is a steady tendency to increase the frequency of myocardial infarction in women of working age. The frequency and severity of AMI in women is underestimated by many researchers, and the prognostic factors of an unfavorable outcome in comparison of female and male individuals are not determined. Objective. The aim of the study was to compare the immediate prognosis and outcome of AMI in women and men, and to identify possible factors leading to an unfavorable outcome. Materials and methods. The analysis of medical cases and pathoanatomical reports of 196 patients who died from AMI within a 5-year period, among whom there were 107 women (average age 72.1±7.2 years) and 89 men (average age 65.4±11.1 years). The authors compared the case, clinical features of the disease, complications, the presence of comorbidities, the depth and localization of AMI, and the direct causes of deaths. Results. In groups comparable in age, the mortality rate in women over 60 years was 1.6 times higher than that in men. Somewhat more often, women died in this case, whose MI began with a typical pain syndrome or an asthmatic variant of it. Concomitant pathology in women who died from MI was significantly more common than in men: arterial hypertension, diabetes mellitus (1.5 times) and obesity (6.5 times). The unfavorable prognostic factors in MI in men can be the previous stroke. Conclusion. The immediate prognosis of mortality in AMI in women is more unfavorable than in men. The immediate causes of death in women compared to men were more often cardiogenic shock, myocardial ruptures and pulmonary embolism, and in men - acute cardiovascular failure and ventricular fibrillation.

Abstract 15755: Differences in Patient Characteristics of Peripartum Spontaneous Coronary Artery Dissection

Background: Spontaneous coronary artery dissection (SCAD) is an important cause of acute myocardial infarction in women. The peripartum period, defined as the last month of pregnancy to three months post-delivery, is known to be associated with SCAD. However, differences in patient characteristics between those with non-peripartum SCAD (npSCAD) and peripartum SCAD (pSCAD) are ill-defined. It is also unknown if the prevalence of extracoronary vascular abnormalities (EVAs) or SCAD recurrence differ between patients with npSCAD and pSCAD. Methods: Patients presenting to a dedicated SCAD clinic were enrolled in a single-center registry. Baseline characteristics, SCAD presentation, lab and imaging results, and recurrent SCAD events were assessed. All patients were screened for EVAs, defined as fibromuscular dysplasia (FMD), aneurysm, pseudoaneurysm, and dissection with cross-sectional imaging. Patient characteristics, clinical presentation, presence of EVAs, and recurrent SCAD events were stratified by peripartum status. Results: 125 SCAD patients were identified from June 2016 to March 2020. Mean age (SD) at 1st SCAD event was 45.8 (10.1) years, 94.4% were female, and 15.2% (19/125) of patients were peripartum. Differences in patient characteristics between npSCAD and pSCAD are outlined in the table. npSCAD patients were older (47.5 (9.76) vs 35.6 (0.93), p= 0.0001) at the time of their 1st SCAD event and had increased rates of hypertension (35.6% (37/105) vs 11.1% (2/18), p=0.04). Those with pSCAD had higher rates of SCAD in the left anterior descending artery (LAD) (64.8% (64/125) vs 89.5% (17/19), p=0.03). There was no significant difference in the prevalence of EVAs or SCAD recurrence between npSCAD and pSCAD. Conclusion: Peripartum SCAD is associated with higher rates of dissection in the LAD compared to non-peripartum SCAD. There is no difference in prevalence of EVAs or recurrent SCAD in patients presenting with pSCAD.

Mesa 1: Diabetes mellitus tipo 1 y enfermedad cardiovascular

La principal causa de muerte en personas con diabetes mellitus tipo 1 (DM1) es de origen cardiovascular (CV). La duración de la DM1 es uno de los predictores más importantes para infarto agudo de miocardio (IAM), junto con el colesterol de lipoproteínas de baja densidad (cLDL) y HbA1c. El desarrollo de DM1 antes de los 10 años de edad se asocia con un riesgo 90 veces mayor de IAM en mujeres. En la DM1 habría una mayor contribución de un estado de inflamación sistémica de bajo de grado.La combinación de electrocardiograma de ejercicio y una técnica de imagen proporciona valor diagnóstico para la detección de isquemia miocárdica y pronóstico. La evaluación del riesgo CV en el adulto mayor debe ser individualizado y categorizarlo según funcionalidad y comorbilidades a fin de fijar objetivos de control de factores glucémicos y no glucémicos personalizados.

Sex-Specific Trends in Acute Myocardial Infarction Within an Integrated Healthcare Network, 2000 Through 2014

In recent decades, the rates of incident acute myocardial infarction (AMI) have declined in the United States, yet disparities by sex remain. In an integrated healthcare delivery system, we examined temporal trends in incident AMI among women and men. We identified hospitalized AMI among members ≥35 years of age in Kaiser Permanente Southern California. The first hospitalization for AMI overall, and for ST-segment-elevation MI and non-ST-segment-elevation MI was identified by International Classification of Diseases, Ninth Revision, Clinical Modification primary discharge diagnosis codes in each calendar year from 2000 through 2014. Age- and sex-standardized incidence rates per 100 000 person-years were calculated by using direct adjustment to the 2010 US Census population. Average annual percent changes (AAPCs) and period percent changes were calculated, and trend tests were conducted using Poisson regression. We identified 45 331 AMI hospitalizations between 2000 and 2014. Age- and sex-standardized incidence rates of AMI declined from 322.4 (95% CI, 311.0-333.9) in 2000 to 174.6 (95% CI, 168.2-181.0) in 2014, representing an AAPC of -4.4% (95% CI, -4.2 to -4.6) and a period percent change of -46.6%. The AAPC for AMI in women was -4.6% (95% CI, -4.1 to -5.2) between 2000 and 2009 and declined to -2.3% (95% CI, -1.2 to -3.4) between 2010 and 2014. The AAPC for AMI in men was stable over the study period (-4.7% [95% CI, -4.4 to -4.9]). The AAPC for ST-segment-elevation MI hospitalization overall was -8.3% (95% CI, -8.0% to -8.6%).The AAPC in ST-segment-elevation MI changed among women in 2009 (2000-2009: -10.2% [95% CI, -9.3 to -11.1] and in 2010-2014: -5.2% [95% CI, -3.1 to -7.3]) while remaining stable among men (-8.0% [95% CI, -7.6 to -8.4]). The AAPC for non-ST-segment-elevation MI hospitalization was smaller than for ST-segment-elevation MI among both women and men (-1.9% [95% CI, -1.5 to -2.3] and -2.8% [95% CI, -2.5 to -3.2], respectively). These results suggest that the incidence of hospitalized AMI declined between 2000 and 2014; however, declines in AMI have slowed among women in comparison with men in recent years. Determining unmet care needs among women may reduce these sex-based AMI disparities.

Percutaneous Coronary Intervention for a Pregnant Woman with Acute ST Elevation Myocardial Infarction: A Case Report

Acute myocardial infarction in women during childbearing age is rare. We report a case of a 40-year-old female patient with no history or cardiovascular risk factors, 24-week pregnant who presented with acute coronary syndrome with an ST-elevation anterior extended complicated by cardiogenic shock. Cardiac ultrasound showed systolic dysfunction of the left ventricle at 30%. Emergency coronary angiography revealed subocclusion of the proximal anterior interventricular artery. We performed a primary angioplasty with placement of a stent after balloon predilation with a satisfactory agiographic result and an improvement in the hemodynamic state. The patient gave birth by cesarean section at 30 weeks of pregnancy after a pocket rupture of infectious waters. The newborn died after 72 hours. After 6 years of evolution, the patient remained asymptomatic under medal treatment.