Gender Differences In Clinical Outcomes Research Articles

GENDER DIFFERENCES IN CLINICAL OUTCOMES AMONG STEMI PATIENTS UNDERGOING PRIMARY PCI

ST-elevation myocardial infarction (STEMI) is a major cause of death worldwide. Primary percutaneous coronary intervention (PCI) is the preferred treatment, restoring coronary blood flow to reduce mortality. However, women often experience worse outcomes after STEMI compared to men. Objective: This study aimed to assess gender differences in clinical outcomes, focusing on in-hospital mortality and heart failure among STEMI patients undergoing primary PCI. Methods: A prospective study was conducted at Lady Reading Hospital Peshawar from January to July 2020. The study included 298 STEMI patients aged 35-70 years who underwent primary PCI. Of these, 154 were females (51.7%) and 144 were males (48.3%). Data on demographics, clinical features, and outcomes were collected. Statistical analysis was performed using SPSS Version 25. Continuous variables were presented as mean ± standard deviation, and categorical variables as percentages. Multivariate logistic regression was applied to control for confounding factors. Results: Female patients showed a higher rate of heart failure (12.8% vs. 6.1%, p=0.011) and in-hospital mortality (7.0% vs. 3.5%, p=0.020) compared to males. The odds ratio for heart failure in females was 0.389 (95% CI 0.185-0.817), and for mortality, it was 0.310 (95% CI 0.111-0.870). Stent thrombosis rates were similar between genders (1.7% each, p=0.707). Major bleeding was more frequent in females (2.3% vs. 1.4%), though the difference was not significant (p=0.770).Conclusion: This study reveals significant gender disparities in STEMI outcomes after primary PCI, with women at greater risk for heart failure and in-hospital mortality. These findings highlight the need for tailored strategies in STEMI management to improve outcomes for women.

Abstract 14654: Contemporary Gender Differences in Clinical Outcomes of Patients With Takotsubo Cardiomyopathy - A United States National Inpatient Sample Database Analysis

Introduction: Takotsubo cardiomyopathy (TCM) is classically more prevalent in females, however whether gender differences exist in clinical outcomes of patients with TCM need further clarification. Given the lower prevalence of TCM in males, limitations of previous research included small sample size and demographic disproportion between groups. The purpose of our study is to analyze gender differences in clinical outcomes of TCM hospitalizations using national inpatient sample (NIS). Methods: We searched the 2020 NIS for TCM hospitalizations using ICD 10 code I51.81. Multivariable logistic regression model adjusted for patient and hospital level confounders was used to compare the clinical outcomes between genders. Results: We identified 41,290 TCM hospitalizations in 2020. Of these 19.9% were males (mean age = 63 years, mean charlson comorbidity index = 3.2) and 80.1% were females (mean age = 68 years, mean charlson comorbidity index = 2.7). Females had a lower risk of inpatient mortality (OR: 0.49, 95% CI 0.41-0.58, p < 0.001), cardiac arrest (OR: 0.58, 95% CI 0.43-0.79, p = 0.001) and cardiogenic shock (OR: 0.67, 95% CI 0.55-0.82, p < 0.001). There was no gender difference in the use of intra-aortic balloon pump (IABP), Impella assist system, or extra-corporeal membrane oxygenation (ECMO) Figure 1. Conclusion: Our findings indicate that despite a higher prevalence of TCM in females, clinical outcomes were worse in males. In our analysis, there was no gender difference in the use of IABP, Impella or ECMO. Future research is needed to better understand clinical predictors of adverse cardiac events in male patients hospitalized with TCM to improve outcomes.

Gender Differences in Clinical Outcomes After Percutaneous Coronary Intervention—Analysis of 15,106 Patients from the Cardiac Registry of Pakistan Database

There is a scarcity of data on gender differences in outcomes during and after percutaneous coronary intervention (PCI) in the South Asian population. We assessed the gender differences in in-hospital mortality and complications in patients who underwent PCI. We conducted a cross-sectional study of 15,106 patients from the CROP (Cardiac Registry of Pakistan) CathPCI database. Logistic regression was used to determine factors associated with in-hospital mortality (primary outcome), access site hematoma, and bleeding complications. Approximately 19.6% were women. Women were older (mean age = 57.3 vs 54.4 years) and had a higher prevalence of diabetes (49.3% vs 32.6%), hypertension (72.8% vs 56.4%), peripheral arterial disease (1.5% vs 1%), and cerebrovascular accident (1.2% vs 0.8%) than men (p <0.05).Unadjusted in-hospital mortality was higher in women than in men (odds ratio [OR]: 1.6, 95% confidence interval [CI] 1.1 to 2.2); however, after adjusting for age, hypertension, diabetes, history of cerebrovascular accident, and ST-elevation myocardial infarction at presentation in the multiple logistic regression model, in-hospital mortality was comparable between men and women (adjusted OR [AOR] 1.2, 95% CI 0.8 to 1.7). The results remained consistent after propensity score matching of 5,904 patients (2,952 in each group, OR 1.3, 95% CI 0.9 to 2.0 for in-hospital mortality). Bleeding complications (1.2% vs 0.4%, AOR 2.6, 95% CI 1.4 to 4.5) and access site hematoma (2% vs 0.6%, AOR 2.8, 95% CI 1.8 to 4.5) were higher in women than in men. In conclusion, the incidence of in-hospital mortality was higher for women versus men, but adjusted risks were similar, likely driven by a greater co-morbidity burden among women.

Gender disparities in ventricular tachycardia: evaluating clinical outcomes and interventions

Abstract Background Gender differences in the etiology of ventricular arrhythmia are well-known and can potentially affect clinical outcomes. Women have been under-represented in studies investigating ventricular tachycardia (VT). Thus, gender differences in clinical outcomes of VT are poorly defined. Purpose We sought to elucidate the clinical outcomes and interventions among women with VT. Methods We used the National Inpatient Sample to identify patients aged 18 and older admitted with VT from 2011 to 2019. Observations missing data on age, sex and mortality were excluded. Baseline characteristics include age, race, and comorbidities related to cardiovascular disease. Severity of comorbidities was assessed via the Deyo-Charlson Comorbidity Index (Deyo-CCI) score. Outcomes investigated include all-cause mortality, major adverse cardiovascular events (MACE), and incidence of catheter ablation, cardioversion, and automated implantable cardioverter defibrillator (AICD) insertion. Gender and outcomes association were analyzed using multivariable logistic regression adjusted for baseline characteristics that were significantly different (P&amp;lt;0.05) between cohorts expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). SPSS v28.0 (IBM, Armonk, NY) was used to carry out all calculations. Results Between 2011 and 2019, there were an estimated 3,544,445 hospital admissions for VT, of which, 33.8% were women, who were more likely to be older (69.2 vs 68.0 years) and of minority descent (30.3% vs 26.7%) compared to men. Women were less likely to have coronary artery disease (43.5% vs 62.2%) or ischemic cardiomyopathy (5.0% vs 11.9%) and had a lower mean Deyo-CCI score (2.2 vs 2.4; p&amp;lt;0.001 for all). Women had a higher incidence of mortality (10.6% vs 9.2%) and ischemic stroke (5.3% vs 4.5%), but less acute coronary syndrome (17.6% vs 21.4%; p&amp;lt;0.001 for all). Overall incidence of MACE was lower among women (28.6% vs 31.4%; p&amp;lt;0.001). Multivariate regression analysis demonstrated that female sex remained independently associated with increased odds for all-cause mortality (aOR: 1.089; 95% CI: [1.062–1.116], p&amp;lt;0.001) although decreased odds for MACE (aOR: 0.952; 95% CI: [0.939–0.965]). Female sex was also independently associated with decreased odds for cardioversion (aOR: 0.936; 95% CI: [0.910–0.963]), AICD insertion, (aOR: 0.737; 95% CI: [0.711–0.764]) and ablation (aOR: 0.806; 95% CI: [0.766–0.847]; all p&amp;lt;0.001). Conclusion In this retrospective analysis of patients hospitalized with VT, women had less coronary artery disease and less MACE, yet all-cause mortality was higher. Female sex was also independently associated with fewer interventions, including AICD insertion and ablation. Although there are gender differences in risk factors and causes of VT, this does not fully explain disparities in care and outcomes. Further studies are needed to explore and elucidate these gender disparities. Funding Acknowledgement Type of funding sources: None.

A-14 Exploring Interactions between Traumatic Brain Injury History and Gender on Medical Comorbidities in Military Veterans: An Epidemiological Analysis in the Million Veteran Program

Abstract Objective: Epidemiological studies of gender differences in clinical outcomes following traumatic brain injury (TBI) are limited, especially among service members and Veterans. This study aimed to examine associations between TBI history and medical comorbidities and explore interactions with self-reported gender using a diverse sample of military Veterans. Method: Participants included 491,604 Veterans (48,646 TBI cases, 442,958 controls; 450,625 men, 40,979 women) who enrolled in the VA’s Million Veteran Program. Outcomes of interest included the following medical condition comorbidities from the MVP Baseline Survey: (1) psychiatric, (2) neurological, (3) cardiovascular, (4) skeletomuscular, and (5) other conditions. We explored the interaction of TBI history and gender on medical comorbidities using adjusted logistic regression models. Results: Veterans with a history of TBI had significantly higher rates of medical comorbidities compared to controls, with the strongest associations observed across psychiatric (adjusted OR’s = 2.10–3.61) and neurological (adjusted OR’s = 1.57–6.08) conditions. Significant interactions of TBI history and gender were observed across the majority of psychiatric and neurological comorbidities. Specifically, female Veterans with TBI history had significantly higher rates of attention-deficit/hyperactivity disorder, anxiety, bipolar disorder, major depressive disorder, personality disorder, headache/migraine, epilepsy, and multiple sclerosis, while male Veterans with TBI history had significantly higher rates of schizophrenia, memory loss or impairment, and spinal cord injury. Conclusions: Results indicate that females and males experience differential clinical outcomes following TBI, particularly for rates of psychiatric and neurological comorbidities. Findings highlight the need for more research on gender differences in the context of TBI to better improve the clinical care offered to this population.

Sex-related differences in clinical outcomes among patients with myocardial infarction with nonobstructive coronary artery disease: A systematic review and meta-analysis

BackgroundAmong patients who present with acute myocardial infarction (MI), 2–6% are found to have non-obstructive coronary arteries (NOCA). Patients with MINOCA are more commonly women and present at a younger age (51–59 years). The influence of sex on adverse event rates remains unclear. MethodsPubMed, MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE, EBSCO, Web of Science and CINAHL databases were searched for trials comparing gender differences in clinical outcomes among patients with MINOCA from inception through April 10, 2022. The primary endpoint of the study was composite major adverse clinical events (MACE) including all-cause mortality, non-fatal MI, stroke, and cardiovascular readmissions, and secondary endpoints were the individual components of the MACE. ResultsSeven studies with a total of 28,671 MINOCA patients were included (n = 11,249 men and n = 17,422 women) over a mean follow-up of 2 years. Women had more MACE than men (10.1% vs. 9.1%, OR 1.15, 1.04–1.23, I2 = 44.7%). Among secondary endpoints, only the incidence of stroke was higher in women (3.5% vs. 2.2%, OR 1.3, 1.01–1.68, I2 = 0%). All-cause mortality, non-fatal MI, and cardiovascular readmissions were not significantly different between the two groups. ConclusionsWe hypothesize that small vessel disease associated with MINOCA drives MACE in women and the diminishing influence of estrogen, hypercoagulability and underprescribing could contribute to the differences sex-related outcomes.

P66 GENDER–RELATED DIFFERENCES IN CLINICAL OUTCOMES AFTER EITHER SINGLE OR DOUBLE LEFT MAIN BIFURCATION STENTING

Abstract Background We sought to examine the impact of gender differences in clinical outcomes at 3 years also comparing the role of double versus single stenting approach for the treatment of coronary unprotected LM bifurcation lesions. Methods We retrospectively analyzed both the procedural and medical data of patients referred to our hub center for complex LM bifurcation disease, treated using Cross–over provisional stenting, T or T–and–Protrusion (TAP), Culotte, and Nano–inverted–T (NIT) techniques between January1st, 2008 to May1st2018. The main outcome of the study was to evaluate the association between gender and target lesion failure (TLF) based on the different stenting technique used. Results Five hundred and sixty–seven patients (251 females, mean age 70.0±10 years, mean Syntax score 31.6±6.3) were evaluated. Cross–over, T or TAP, culotte and NIT techniques were performed in 171 (30.1%), 61 (10.7%), 98(17.2%) and 237 (41.8%) patients, respectively with no differences in baseline and peri–procedural items among gender. At a mean follow–up of 37.1±10.8 months (range 22.1–39.3 moths), the overall TLF rate, cardiovascular mortality and stent thrombosis were 12.1%, 3.1% and 1.0%, respectively. Female gender was associated with an increased rate of major bleeding when treated with double stent strategy (p = 0.02). No gender difference in TLF was noted among gender, independently from the stenting approach used. Conclusions Among patients with ULM bifurcation disease undergoing PCI, TLF rates were not different between genders at 3–year follow–up either using a single or double stent technique.

Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study.

We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients. From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set. Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02-1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09-1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62-0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04-1.51), and complete recanalization (OR 1.29; 95% CI 1.09-1.53). Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment.

Gender-related differences in clinical outcomes after either single or double left main bifurcation stenting.

We sought to examine the impact of gender differences in clinical outcomes at 3years also comparing the role of double versus single stenting approach for the treatment of coronary unprotected LM bifurcation lesions. We retrospectively analyzed both the procedural and medical data of patients referred to our hub center for complex LM bifurcation disease, treated using Crossover provisional stenting, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT) techniques between January 1st, 2008 and May 1st 2018. The main outcome of the study was to evaluate the association between gender and target lesion failure (TLF) based on the different stenting technique used. Five hundred and sixty-seven patients (251 females, mean age 70.0 ± 10years, mean Syntax score 31.6 ± 6.3) were evaluated. Crossover, T or TAP, culotte and NIT techniques were performed in 171 (30.1%), 61 (10.7%), 98 (17.2%) and 237 (41.8%) patients, respectively with no differences in baseline and peri-procedural items among gender. At a mean follow-up of 37.1 ± 10.8months (range 22.1-39.3 moths), the overall TLF rate, cardiovascular mortality and stent thrombosis were 12.1%, 3.1% and 1.0%, respectively. Female gender was associated with an increased rate of major bleeding when treated with double stent strategy (p = 0.02). No gender difference in TLF was noted among gender, independently from the stenting approach used. Among patients with ULM bifurcation disease undergoing PCI, TLF rates were not different between genders at 3-year follow-up either using a single or double stent technique.

Gender differences in clinical outcomes in myasthenia gravis: A prospective cohort study.

It is uncertain whether clinical outcomes differ between male and female patients with myasthenia gravis (MG) while receiving standard clinical care. In a prospective cohort study of 107 patients with MG receiving standard of care from 2012 to 2019, the Quantitative MG (QMG), the MG Composite (MGC), the MG Activities of Daily Living (MG-ADL), and the MG Quality of Life 15-Items (QOL15) were determined. Clinical outcomes were analyzed in relation to gender. Mean follow-up time was 4.8 (±0.4) y, and 70 patients completed all follow-up assessments. Patients improved on all clinical scores: QMG -1.8 (P < .001), MGC -1.5 (P < .001), MG-ADL -1.3 (P < .001), and QOL15 -3.0 (P < .001). Females improved less than males on the QMG (P=.01), MGC (P < .001), MG-ADL (P=.006), and QOL15 (P < .001) independent of potential confounders. Males had moderate to strong correlations between changes in all clinical scales (r range 0.52 to 0.73), whereas females had weak correlations between changes in the QMG and MG-ADL (r=0.13), the QMG and QOL15 (r=0.27), the MGC and MG-ADL (r=0.21), the MGC and QOL15 (r=0.00), and the MG-ADL and QOL15 (r =0.31). Females improved less compared to males on objective and patient-reported outcomes. Moreover, females improved more on objective measures than on patient-reported outcomes. These gender differences should receive attention in clinical care and in the design of future trials.

Gender differences in clinical outcomes of acute myocardial infarction undergoing percutaneous coronary intervention: insights from the KAMIR-NIH Registry.

BackgroundThere are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention (PCI). Furthermore, gender differences in clinical outcomes with acute myocardial infarction (AMI) following PCI in Asian population remain uncertain because of the under-representation of Asian in previous trials.MethodsA total of 13, 104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into male (n = 8021, 75.9%) and female (n = 2547, 24.1%). We compared the demographic, clinical and angiographic characteristics, 30-days and 1-year major adverse cardiac and cerebrovascular events (MACCE) in women with those in men after AMI by using propensity score (PS) matching.ResultsCompared with men, women were older, had more comorbidities and more often presented with non-ST segment elevation myocardial infarction (NSTEMI) and reduced left ventricular systolic function. Over the median follow-up of 363 days, gender differences in both 30-days and 1-year MACCE as well as thrombolysis in myocardial infarction minor bleeding risk were not observed in the PS matched population (30-days MACCE: 5.3% vs. 4.7%, log-rank P = 0.494, HR = 1.126, 95% CI: 0.800-1.585; 1-year MACCE: 9.3% vs. 9.0%, log-rank P = 0.803, HR = 1.032, 95% CI: 0.802-1.328; TIMI minor bleeding: 4.9% vs. 3.9%, log-rank P= 0.215, HR = 1.255, 95% CI: 0.869-1.814).ConclusionsAmong Korean AMI population undergoing contemporary PCI, women, as compared with men, had different clinical and angiographic characteristics but showed similar 30-days and 1-year clinical outcomes. The risk of bleeding after PCI was comparable between men and women during one-year follow up.

Abstract 337: Gender Differences and Outcome After Isolated Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis

Background: Coronary artery bypass grafting (CABG) is among the most common surgical procedures performed in developed nations. In spite of this, studies have reported gender differences in clinical outcome exist in outcome after CABG. As data is limited to observational studies, we performed a systematic review to compare CABG outcome between women and men. Methods: We queried databases (1 st January 2000 - 20 th January 2020) to identify original studies comparing CABG outcome between genders. Our aims were (1) to study differences in risk factors (2) to compare early mortality, stroke, wound infection, acute kidney injury rates and long-term survival. We pooled risk ratios (RR) with inverse variance weighting and a random effects model for early end-points. Long-term survival was compared using incident risk ratios (IRR). All results are presented with their 95% confidence interval. Results: We identified 24 observational studies (1,647,035 women and 3,642,057 men) from 13 countries for inclusion. At time of CABG, women were older (66 vs 64 years; p &lt; 0.01) and had a higher incidence of diabetes mellitus (32% vs 24%; p &lt; 0.01), congestive heart failure (12% vs 8%; p &lt; 0.01) and emergent surgery (13% vs 9%). More men had left ventricular dysfunction (12% vs 10%; p &lt; 0.01) and prior myocardial infarction (40% vs 37%). Women received fewer grafts (mean difference -0.22; p &lt; 0.01) and arterial conduits (OR 0.51, CI 0.41 - 0.63; p &lt; 0.01). Early mortality (4% vs 2.5%, OR 1.5, CI 1.4 - 1.7) and stroke rates (OR 1.9, CI 1.3 - 1.7) were higher in women. Sternal wound infection (4.7% vs 2%) was also higher in women (OR 1.8, CI 1.1 - 1.8, p = 0.001). Acute kidney injury (OR 1.1, p = 0.09) and long-term survival (IRR 0.9, CI 0.8 - 1.2, p = 0.9) are comparable. Conclusion: Our meta-analysis demonstrates that women and men have significant differences in presentation and outcome after CABG. While women have worse post-operative outcomes, long-term survival is comparable.

Gender Differences in Clinical Outcomes after Left Ventricular Assist Device (LVAD) Implantation - Does Device Strategy Matter?

Findings regarding outcomes after LVAD implantation in women and men are inconsistent, which may be due to combining data from patients differing in device strategy. The present analyses explored gender differences at baseline in medical and psychosocial patient characteristics and multiple clinical outcomes, stratified for patients bridged to transplantation (BTT) and those intended for destination therapy (DT). 8,461 patients in DT (20% women), and 11,189 patients in BTT (22% women), who received a primary continuous-flow LVAD between 6/2006 and 12/2017 and were registered with INTERMACS, were analyzed by device strategy and gender. Outcomes included death, transplant, device explant due to recovery, and device replacement due to complications. Associations of gender with time until each competing outcome were evaluated using cumulative incidence function and cause-specific Cox proportional hazard models, controlling for age, disease severity, hematological parameters, and psychosocial factors (e.g., marital status, social support, depression, history of alcohol abuse, and smoking). In both BTT and DT, women were younger, reported less substance abuse, were less likely to be white, married and working for an income, but more likely to be depressed than men. In BTT, men were more likely to be currently smoking, whereas in DT, women were more likely to be smoking. In DT, women were also more likely to be overweight. Regarding outcomes, during a mean follow up of 19 months, women had an increased rate of death compared to men in BTT [HR 1.11, 95% CI (1.00-1.23), p < .05], but not in DT [HR 1.01, 95% CI (0.91-1.12)]; women's rate of device replacement, however was increased only in DT [HR 1.19, 95% CI (1.03-1.39), p < .05]. Only in BTT had women a lower rate to be transplanted than men [HR 0.83, 95% CI (0.76-0.90), p < .001]. In both BTT and DT, women had higher rates for explant due to heart function recovery than men, even after controlling for medical and psychosocial covariates [DT: HR 1.79, 95% CI (1.27-2.56), p < .01; BTT: HR 1.33 95% CI (1.00-1.79), p < .05]. The results indicate that women and men differ in outcomes depending on intended device strategy. Thus, distinguishing between device strategies may help to understand gender differences in clinical outcomes after LVAD implantation.

Age and gender differences in clinical outcomes of patients with heavy-calcified coronary artery lesions treated percutaneously with rotational atherectomy.

Rotational atherectomy (RA) used in elderly patients treated with percutaneous coronary interventions (PCI) could enable revascularization or the omission of cardiac surgery. Knowledge about factors affecting the prognosis may improve the results of treatment. We aimed to assess the relationship of gender and age with long-term clinical outcomes expressed as major adverse cardiac and cerebrovascular events (MACCEs). The study included 97 consecutive patients treated with PCI and RA at the mean age of 71. The study group contained 73.2% men and 26.8% women, 36.1% of patients older than 75 and 63.9% younger than 75. The mean time of follow-up was 695.3 ±560.9 days. The rate of MACCEs (deaths, myocardial infarctions (MIs), reinterventions, coronary artery by-pass surgeries, or cerebral strokes (CSs)/transient ischemic attacks (TIAs)) in the overall group of patients was calculated at 33.7%. The comparison of Kaplan-Meier survival curves did not depict significant differences in the frequency of MACCEs for age (p = 0.36) and gender (p = 0.07). We noticed that the death rate was higher in females than in males and in patients older than 75 compared to those younger, and was statistically significant for age (p = 0.04). The rate of periprocedural complications was significantly higher among women than among men (p = 0.005) and in patients older than 75 compared to the younger ones (p = 0.003). Age and gender are not significantly associated with an increased rate of MACCEs during follow-up in elderly patients treated with PCI and RA.

Male sex adversely affects the phenotypic expression of diabetic heart disease.

Background:Type 2 diabetes (T2D) is associated with an increased risk of heart failure (HF) and cardiovascular mortality. A large-scale meta-analysis on HF found that diabetes was more frequent in women than men, and diabetes appeared to have attenuated the otherwise protective effect of female sex on progression of cardiomyopathy. The exact underlying mechanisms for this remain unclear. Here, we aimed to determine the effect of sex on the phenotypic expression of diabetic heart disease in patients with T2D.Methods:A total of 62 male [mean age 44 ± 8 years, body mass index (BMI) 33 ± 5 kg/m2, mean HBA1c of 7.8 ± 1.8%] and 67 female (44 ± 10 years, BMI 35 ± 6 kg/m2, HBA1c 7.6 ± 1.2%) T2D patients on oral glucose-lowering treatment, and 16 male (48 ± 17 years, BMI 25 ± 3 kg/m2) and 14 female (50 ± 10 years, BMI 25 ± 4 kg/m2) controls were recruited. Left ventricular (LV) volumes, mass, function and deformation, and left atrial (LA) volumes and function were assessed using cardiac magnetic resonance imaging (CMR).Results:Participants in all groups were of similar age, and there were no significant differences in blood pressure (BP), diabetes duration or metabolic profile between the two diabetes groups. Concentric remodeling was present in both sexes (p < 0.0001), with greater degree of concentric hypertrophy in males (12%, p = 0.0015). Biplane LA ejection fraction (LAEF) (p = 0.038), peak systolic circumferential strain (p < 0.0001) and diastolic strain rates (p = 0.001) were significantly reduced in men compared with women with T2D. There were no significant differences in biplane LAEF, peak systolic circumferential strain and diastolic strain rates in women with T2D compared with female controls. Whereas in women with T2D, glycaemic control was linked to LV contractile function, there was no such relationship in men with T2D.Conclusion:Male sex adversely affects the phenotypic expression of diabetic heart disease. The striking differences in the cardiac phenotype between male and female patients with T2D promote awareness of gender-specific risk factors in search of treatment and prevention of diabetes-associated HF.Condensed :We aimed to determine the effect of sex on the phenotypic expression of diabetic heart disease in patients with T2D. While our findings support the notion that in T2D, male sex adversely affects the phenotypic expression of diabetic heart disease, this is in apparent conflict with the previous large-scale study showing diabetes attenuates the otherwise protective effect of female sex on progression of cardiomyopathy. Further longitudinal studies looking at gender differences in clinical outcomes in T2D patients are needed. These sex-related differences promote awareness of sex-specific risk factors in search of treatment and prevention of diabetes-associated HF.

Gender Differences in Long-Term Outcomes of Medical Therapy and Successful Percutaneous Coronary Intervention for Coronary Chronic Total Occlusions.

Background There is a paucity of information about the gender differences in clinical outcomes of successful percutaneous coronary intervention (PCI) compared with medical therapy (MT) in patients with coronary chronic total occlusions (CTOs). Objectives We aimed to investigate the impact of gender on long-term clinical outcomes associated with successful CTO-PCI versus MT in patients with CTOs. Methods Between January 2007 and December 2016, a total of 1702 patients with ≥1 CTO were enrolled. After exclusion, 1294 patients with 1520 CTOs were analyzed and were divided into the female group (n = 304, 23.5%) and the male group (n = 990, 76.5%). The patients in the female or male group were assigned to a MT group or successful CTO-PCI group according to the treatment strategy. In the female group, they were divided into two groups: 177 patients in the MT group and 127 patients in the successful CTO-PCI group. In the male group, they were divided into two groups: 623 patients in the MT group and 367 patients in the successful CTO-PCI group. The primary outcome was cardiac death. The secondary outcome was major adverse cardiac event (MACE). Results The median overall follow-up duration was 3.6 (IQR, 2.1–5.0) years, there were no significant differences between the MT and successful CTO-PCI groups with respect to the prevalence of cardiac death (MT vs. successful PCI: 6.8% vs. 3.9%, p=0.287) and MACE (20.9% vs. 21.3%, p=0.810) in female patients. In the male group, the occurrence of cardiac death (MT vs. successful PCI: 6.6% vs. 3.8%, p=0.066) was similar between the two groups. The MACE rate (30.0% vs. 18.5%, p < 0.001) was significantly higher in the MT group. Heart failure (hazard ratio 3.40, 95% confidence interval 1.23–9.40, p=0.018) was an independent predictor of cardiac death in female patients. Conclusions Successful CTO-PCI was not associated with reduced risk of cardiac death compared with medical therapy alone in both female and male patients. However, men have a significant reduction in MACE rate after successful CTO-PCI. Aggressive CTO-PCI should be considered carefully among female patients.

An Asian Perspective on Gender Differences in Clinical Outcomes and Echocardiographic Profiles of Patients With Medically Managed Severe Aortic Stenosis

Gender differences in valvular heart disease are increasingly recognised. A prior study has suggested better surgical outcomes in women with symptomatic aortic stenosis (AS). We investigate gender differences in medically managed severe AS. We studied 347 patients with severe AS (aortic valve area index <0.6 cm2/m2) in terms of baseline clinical background, echocardiographic characteristics, and clinical outcomes. Appropriate univariate and multivariate models were employed, while Kaplan-Meier curves were constructed to compare mortality outcomes. In total, 205 (59%) patients were women. Despite higher incidences of hypertension (75.6% vs 47.3%) and diabetes mellitus (46.5% vs 29.5%) in women, women had improved survival (Kaplan-Meier log-rank = 6.24, p = 0.012). After adjusting for age (hazard ratio [HR], 1.034; 95% confidence interval [CI], 1.014-1.054), hypertension (HR, 1.469; 95% CI, 0.807-2.673), diabetes (HR, 1.219; 95% CI, 0.693-2.145), and indexed aortic valve area (HR 0.145, 95% CI 0.031-0.684) on multivariate analyses, female gender remained independently associated with lower mortality (HR, 0.561; 95%, CI 0.332-0.947). Women tended to have smaller body surface area (BSA), left ventricular (LV) internal diastolic diameter, and smaller LV outflow tract diameter but were similar to men in terms of LV ejection fraction, AS severity, and patterns of LV remodelling. Women appeared to have better outcomes compared to men in medically managed severe AS. These gender differences warrant further study and may affect prognosis, follow-up, and timing of valve surgery.

Gender Difference in Clinical Outcomes after Percutaneous Left Atrial Appendage Closure in Patients with Atrial Fibrillation

Gender Difference in Clinical Outcomes after Percutaneous Left Atrial Appendage Closure in Patients with Atrial Fibrillation

Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention

Previous researches have reported the controversial results regarding the gender difference in clinical outcomes of patients with coronary artery disease after percutaneous coronary intervention. Hence, this systematic review and meta-analysis was designed to investigate whether gender difference existed in patients with coronary artery disease after percutaneous coronary intervention. PubMed, Embase, and the Cochrane Library database were searched up to February 10, 2018. Studies comparing the gender-specific effect on clinical outcomes of patients with coronary artery disease after percutaneous coronary intervention were identified, to analyze mortality, major adverse cardiovascular events (MACE) and revascularization. Statistical software RevMan was utilized in this meta-analysis. A total of 49 studies, involving 1,032,828 patients (774,115 males and 258,713 females) reporting gender-specific outcomes, were included in this study. The in-hospital mortality, 30-day mortality, 1-year mortality, and at least 2-years mortality in male patients with coronary artery disease after percutaneous coronary intervention were significantly lower than those of females (odds ratio [OR] 0.58 95% confidence interval [CI] 0.52-0.63, P < .001; OR 0.64, 95% CI 0.61-0.66, P = .04; OR 0.67, 95% CI 0.60-0.75, P < .001 and OR 0.71, 95% CI 0.63-0.79, P = .005, respectively). The MACE was significantly decreased in male subjects after initial percutaneous coronary intervention compared with females in <1-year or at least 1-year (OR 0.67, 95% CI 0.56-0.80, P < .001 and OR 0.84, 95% CI 0.76-0.93, P < .001). The male patients after percutaneous coronary intervention harbored higher rate of revascularization compared with females for at least 1-year (OR 1.17, 95% CI 1.00-1.36, P < .001), while the rate of revascularization in male patients for < 1-year was lower than that of females (OR 0.93, 95% CI 0.69-1.26, P < .001). The systematic review and meta-analysis suggests that the prognosis of male patients with coronary artery disease after percutaneous coronary intervention is better than that of females, except for long-term revascularization.

Familial Sex Trafficking of Minors: Trafficking Conditions, Clinical Presentation, and System Involvement

It is well documented in the literature that child sex trafficking can be perpetrated by family members, though limited research has focused on describing this type of sexual exploitation. This pilot study addresses this gap by providing an analysis of familial sex trafficking considering trafficking dynamics, and rurality. Using a sample of 31 child welfare-involved children referred for behavioral health assessment and treatment, this mixed methods study explores: (1) victim and trafficker characteristics, the trafficking situation, law enforcement classifications of trafficking, clinical profiles of victims, and system involvement of children and youth involved in familial sex trafficking; (2) gender differences in clinical outcomes in sex-trafficked children; and (3) geographical differences in severity of the victimization experience. Major findings document high rates of family members trafficking children for illicit drugs; high severity of abuse as measured with the Sexual Abuse Severity Score, with higher severity of abuse for children living in rural communities; clinical threshold level scores on the Child Behavior Checklist (CBCL), and the Trauma Symptom Checklist for Children (TSCC-A). Boys and girls had similar clinical profiles except boys had higher CBCL externalizing scores, and females had higher TSCC depression scores. Additionally, more than half of the children in this sample had attempted suicide in their lifetime. This formative study sheds light on the phenomenon of familial sex trafficking, thereby creating the context for further investigations. Implications for identification and effective responses to familial sex trafficking, with specific attention to gender and geography are discussed.