Infarction In Women Research Articles

P2655ST-elevation myocardial infarction in women: a more satisfactory outcome?

Abstract Background Despite all the advances registered in the last decade regarding acute myocardial infarction with ST-segment elevation (STEMI) treatment, this entity remains prevalent and highly lethal. Women constitute a lower proportion of STEMI patients, however, they show important differences when compared to men. Thanks to the lower representation of women in STEMI trials, less is know about this patient subpopulation. Purpose To determine and understand gender differences in patients admitted with STEMI in a coronary care unit (CCU). Methods Observational retrospective study of patients admitted with STEMI in a CCU, between 2006 and 2017. Patients were split between groups according to gender and were assessed in terms of risk factors, diagnosis, treatment, complications and mortality. Results A total of 2516 patients were included in the study. 1833 were men (72.9%) and 682 were women (27.1%). Mean age was superior in women (73.3±13.2 vs. 64.1±12.8 years, p<0.001), and displayed a greater cardiovascular comorbidity burden such as hypertension (79.6% vs. 66.2%, p<0.001) and diabetes (55.8% vs. 45.3%, p<0.001). At admission time women registered a higher mean TIMI (2.79 vs. 2.62, p=0.009) and GRACE score (166.3 vs. 146.3, p<0.001) which did not reflect in a higher hospital stay (mean 4.75 vs. 5.29 days, p=0.043). Before admission women were less treated with aspirin (26.4% vs. 33.2%, p=0.014) and statins (36.8% vs. 46.5%, p=0.001). There were no differences regarding access to revascularization (98% vs. 96.5%, p=0.105) but women presented more normal coronary angiographies (10.2% vs. 3.6%, p<0.001). During hospital stay, women evolved more to Killip-Kimball (KK) class III (4.5% vs. 1.9%, p<0.001) and KK class IV (15.9% vs. 11.2%, p<0.001). Intra-hospital (13.9% vs. 8.2%, p<0.001), 1-month (18.4% vs. 13.2%, p<0.001), 6-month (22.2% vs. 16.1%, p<0.001) and 1-year mortality (25.7% vs. 17.8%, p<0.01) was superior in women. After multivariate analysis heart failure on admission (OR 9.2, CI 95% 6.7–12.8), intravenous amiodarone use (OR 3.5, CI 95% 2.5–4.8), diabetes (OR 2.3, CI 95% 1.8–2.8), female gender (OR 1.6, CI 95% 1.3–2.0) and peak serum creatinine during hospital stay (OR 1.7, CI 95% 1.6–1.9) were independent predictors of 1-year mortality. After adjustment for age, diabetes, hypertension, previous acute myocardial infarction and initial KK, female gender maintained its potency as a significant 1-year mortality predictor. Conclusions Women presenting with STEMI register poorer outcomes compared to men. In our study, female gender was considered a good independent predictor of short-term and long-term mortality.

Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome

BackgroundMajor disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized. ObjectivesThe aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome. MethodsConsecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury was defined as high-sensitivity cardiac troponin I concentration >99th centile of 16 ng/l in women and 34 ng/l in men. The primary outcome was recurrent myocardial infarction or cardiovascular death at 1 year. ResultsA total of 48,282 patients (47% women) were included. Use of the high-sensitivity cardiac troponin I assay with sex-specific thresholds increased myocardial injury in women by 42% and in men by 6%. Following implementation, women with myocardial injury remained less likely than men to undergo coronary revascularization (15% vs. 34%) and to receive dual antiplatelet (26% vs. 43%), statin (16% vs. 26%), or other preventive therapies (p < 0.001 for all). The primary outcome occurred in 18% (369 of 2,072) and 17% (488 of 2,919) of women with myocardial injury before and after implementation, respectively (adjusted hazard ratio: 1.11; 95% confidence interval: 0.92 to 1.33), compared with 18% (370 of 2,044) and 15% (513 of 3,325) of men (adjusted hazard ratio: 0.85; 95% confidence interval: 0.71 to 1.01). ConclusionsUse of sex-specific thresholds identified 5 times more additional women than men with myocardial injury. Despite this increase, women received approximately one-half the number of treatments for coronary artery disease as men, and outcomes were not improved. (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]; NCT01852123).

Risk factors for development of myocardial infarction in women with preserved reproductive function

Aim. Identification of risk factors (RF) for myocardial infarction (MI) among women with preserved menstrual function.&#x0D; Material and Methods. 121 Female patients under 55 years of age, who were hospitalized with MI in the cardiology departments of Ryazan in the period 2010-2016, were studied. All patients were divided into 2 groups. The first group included women with a regular menstrual cycle without menopausal symptoms (n=60, mean age 48.0±6.1 years). The second group consisted of postmenopausal women (n=61, mean age 49.8±4.3 years). Of a cohort of studied women a group of women was isolated (n=18 from group 1 and n=15 from group 2) who, during hospitalization with MI in 2015-2016, filled in questionnaires on nutrition and physical activity.&#x0D; Results. In women of group 1 such risk factors as burdened heredity for cardiovascular diseases (58.3%, p=0.02) and smoking (46.7%, p=0.03) were more common than in women of group 2. Only women of group 1 took oral contraceptives before the onset of MI (15%, p=0.005). The most common RFs were: arterial hypertension (˃80% of patients in both groups; overweight and obesity (78.3% of women from group 1 and 83.6% from group 2); type 2 diabetes mellitus (23.3% in group 1 and 24.6% in group 2). According to the results of the questionnaire on food habits, insufficient use of fruit and vegetables was detected among all patients of both groups. In analysis of the results of the International Physical Activity Questionnaire (IPAQ), 72.2% of patients in group 1 experienced insufficient physical activity, and 53.3% of patients in group 2 showed pronounced hypodynamia. Biochemical analysis of blood revealed increased average levels of total cholesterol, low-density lipoproteins and triglycerides, with high-density lipoproteins within the normal range in both groups.&#x0D; Conclusion. The most common risk factors for myocardial infarction in women with preserved menstrual function in comparison with postmenopausal women were: positive heredity for cardiovascular diseases, smoking and taking oral contraceptives. Besides, a wide spread of arterial hypertension, dyslipidemia and diabetes mellitus, overweight and obesity, low physical activity and lack of fruit and vegetables in the diet of women in both groups should be noted.

Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing

ObjectivesGiven the uncertainty regarding the degree and prevalence of spontaneous healing following spontaneous coronary artery dissection (SCAD), the aim of this study was to assess the angiographic characteristics of the dissected segments in a large cohort of patients with SCAD who underwent subsequent repeat coronary angiography. BackgroundSCAD is an uncommon yet important cause of myocardial infarction in women. Very little is known about the characteristics of healing of dissected arteries. MethodsPatients with nonatherosclerotic SCAD followed prospectively at Vancouver General Hospital who underwent repeat angiography were included in this study. Those who underwent percutaneous coronary intervention for SCAD were excluded. Baseline patient demographics and in-hospital and long-term cardiovascular events were recorded. Angiographic characteristics of the SCAD artery at index and repeat angiography were assessed by 2 experienced angiographers. Criteria for angiographic healing were as follows: 1) improvement of stenosis severity from index event; 2) residual stenosis <50%; and 3) TIMI (Thrombolysis In Myocardial Infarction) flow grade 3. ResultsOne hundred fifty-six patients with 182 noncontiguous SCAD lesions were included. The mean age was 51.5 ± 8.7 years, 88.5% were women, 83.3% were Caucasian, and 75.6% had fibromuscular dysplasia. All patients presented with myocardial infarction. At index angiography, type 2 SCAD was most commonly observed, in 126 of 182 lesions (69.2%); TIMI flow grade <3 was present in 85 of 182 (46.7%); and median lesion stenosis was 79.0% (interquartile range: 56.0% to 100%). Median time to repeat angiography was 154 days (interquartile range: 70 to 604 days), with median residual lesion stenosis improving to 25.5% (interquartile range: 12.0 to 38.8 days), and TIMI flow grade <3 observed in 10 of 182 lesions (5.5%). Angiographic healing occurred in 157 of 182 lesions (86.3%). Of repeat angiography performed ≥30 days post-SCAD, 152 of 160 (95%) showed spontaneous angiographic healing. ConclusionsThe majority of coronary arteries affected by SCAD heal spontaneously on repeat angiography, with apparent time dependency, with the vast majority having complete healing after 30 days from the SCAD event.

Association between tamoxifen use and acute myocardial infarction in women with breast cancer.

The relationship between tamoxifen use and acute myocardial infarction in women with breast cancer remains uncertain. The goal of the study was to assess whether tamoxifen use could be associated with acute myocardial infarction in women with breast cancer in Taiwan.A population-based case–control study was conducted to analyze the database of the Taiwan National Health Insurance Program. Totally, 489 women with breast cancer aged 20 to 84 years having the first episode of acute myocardial infarction from 2000 to 2011 were found as the cases. In addition, 1718 women with breast cancer aged 20 to 84 years without any type of ischemic heart disease were selected as the matched controls. Ever use of tamoxifen was classified as the studied women who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was classified as the studied women who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval (CI) for acute myocardial infarction associated with tamoxifen use.In a multivariable-adjusted analysis, women with acute myocardial infarction were 1.71 times more likely to be exposed to tamoxifen than those women without acute myocardial infarction (adjusted OR 1.71, 95% CI 1.38–2.13).The odds of tamoxifen use are 1.71 times higher in women with acute myocardial infarction versus those women without acute myocardial infarction in Taiwan.

Quality of life after myocardial infarction in women from rural India

Introduction: Health expenditures in survivors of myocardial infarction (MI) causes increased financial burden. Secondary prevention strategy can be planned with knowledge of health-related quality of life (HRQoL) in survivors of MI. Aim: To study HRQOL using Mac New Heart questionnaire. Objective: Female survivors of MI will undergo the questionnaire and the scores across physical, social and emotional domains will be noted. Material and Methods: Observational study. Female survivors of MI attending follow up in cardiac outpatient department between January 2017 and January 2018 were subjected to MacNew Heart Disease HRQoL questionnaire. Statistical Analysis Used: Pearson's correlation coefficient; software used was SPSS 22.0 version. Results: Mean age 60 years; mean duration since MI – 7.88 months; 74% were married and 88% on vegetarian diet. Those women with mean age of 40 years, vegetarian and married had better mean scores. The emotional score improved over a period of time whereas the physical and social score remained the same. Conclusion: Female survivors above 40 years showed poor scores across all three domains and therefore need early cardiac rehabilitation as also long-term follow up.

Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard...

Sex-Specific Versus Overall Clinical Decision Limits for Cardiac Troponin I and T for the Diagnosis of Acute Myocardial Infarction: A Systematic Review.

The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations. We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23-30 ng/L; hs-cTnT, 13-25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5%) and 11 (61.1%) studies reported lower female-specific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90% concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4% vs 80.0% of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively). Our data show substantially lower female-specific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.

Outcomes After Coronary Stenting or Bypass Surgery for Men and Women With Unprotected Left Main Disease: The EXCEL Trial

ObjectivesThe aim of the present study was to assess outcomes after coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI) according to sex in a large randomized trial of patients with unprotected left main disease. BackgroundIn the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, sex had a significant interaction effect with revascularization strategy, and women had an overall higher mortality when treated with PCI than CABG. MethodsThe EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial was a multinational randomized trial that compared PCI with everolimus-eluting stents and CABG in patients with unprotected left main disease. The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke at 3 years. ResultsOf 1,905 patients randomized, 1,464 (76.9%) were men and 441 (23.1%) were women. Compared with men, women were older; had higher prevalence rates of hypertension, hyperlipidemia, and diabetes; and were less commonly smokers but had lower coronary anatomic burden and complexity (mean SYNTAX score 24.2 vs. 27.2, p < 0.001). By multivariate analysis, sex was not independently associated with either the primary endpoint (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 0.82 to 1.48; p = 0.53) or all-cause death (HR: 1.39; 95% CI: 0.92 to 2.10; p = 0.12) at 3 years. At 30 days, all-cause death, myocardial infarction, or stroke had occurred in 8.9% of woman treated with PCI, 6.2% of women treated with CABG, 3.6% of men treated with PCI, and 8.4% of men treated with CABG (p for interaction = 0.003). The 3-year rate of the composite primary endpoint was 19.7% in women treated with PCI, 14.6% in women treated with CABG, 13.8% in men treated with PCI, and 14.7% in men treated with CABG (p for interaction = 0.06). These differences were driven by higher periprocedural rates of myocardial infarction in women after PCI and in men after CABG. ConclusionsIn patients with unprotected left main disease in the EXCEL trial, sex was not an independent predictor of adverse outcomes after revascularization. However, women undergoing PCI had a trend toward worse outcomes, a finding related to associated comorbidities and increased periprocedural complications. Further studies are required to determine the optimal revascularization modality in women with complex coronary artery disease.

Women’s Health in the Lund Area (WHILA) study. Health problems and acute myocardial infarction in women – A 17-year follow-up study

ObjectivesThe literature has highlighted the importance of identifying symptoms predictive of acute myocardial infarction (AMI) in women, in addition to traditional cardiovascular risk factors. The objective was to study subjective health problems, in relation to later AMI, in a large sample of women, adjusted for age, educational status, smoking, waist/hip ratio, blood pressure, total cholesterol/HDL ratio, diabetes and neighbourhood socioeconomic status. Study designFrom December 1995 to February 2000 a cohort of 6711 women aged 50–59 years in southern Sweden underwent a physical examination and answered a questionnaire that had 18 items on health problems such as stress symptoms, tiredness and pain. Main outcome measuresIncidence of AMI during a mean follow-up of 17 years, drawn from national registers. ResultsThe number of health problems showed a J-shaped relationship with AMI, with the lowest hazard ratio (HR) in women with a median of 4 health problems. The HR for AMI in women with 0 health problems was 1.58 (95% CI: 0.95–2.63) and in those with 13 problems HR 1.65 (95% CI 1.16–2.36), after adjusting for potential confounding factors. ConclusionsThe presence of several health problems, including pain and stress symptoms, is associated with an increased risk of later AMI in middle-aged women. Awareness among clinicians of predictive risk factors for AMI is important for the early identification of individuals at higher risk.

2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.

The American College of Cardiology (ACC)/American Heart Association (AHA) performance measurement sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of performance measure development1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including …

Abstract 91: Moyamoya Disease Susceptibility Gene, RNF213 p.R4810K Variant, is a Common Risk Factor for Atherothrombotic Brain Infarction in a Japanese Population

Background and Purpose: RNF213 has been identified as a susceptibility gene for moyamoya disease. The p.R4810K variant is found in about 80% of East Asian patients with moyamoya disease, and 20 - 25% of those with proximal intracranial arterial stenosis. In this study, we examined the association of RNF213 p.R4810K variant with non-cardioembolic stroke in a Japanese population. Methods: We analyzed 383 consecutive patients with acute non-cardioembolic stroke, who were admitted to the National Cerebral and Cardiovascular Center from June 2012 to May 2017 and participated in NCVC Biobank, and 1011 healthy local Japanese controls. Patients diagnosed with moyamoya disease were excluded. Written informed consent was obtained from all study participants. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for age, sex, and conventional risk factors for stroke. Results: The RNF213 p.R4810K variant was found in 5.2% of acute non-cardioembolic stroke patients and in 2.1% of healthy controls (adjusted OR 3.9, 95% CI 1.6 - 9.3, p=0.003). The mean age of stroke onset was lower in patients with the RNF213 p.R4810K variant than those without the variant (58.1±15.5 years vs. 69.1±13.2 years, p&lt;0.001). Among stroke subtypes, only atherothrombotic brain infarction (ATBI) was significantly associated with this variant (adjusted OR 11.5, 95% CI 3.4 - 36.2, p&lt;0.001, see also Table 1). When stratified by sex, these associations were more evident in women (Men: adjusted OR for ATBI 1.9, 95% CI 0.3 - 10.2, p=0.47; Women: adjusted OR for ATBI 58.0, 95% CI 10.3 - 327.3, p&lt;0.001, see also Table 1). Conclusion: The RNF213 p.R4810K variant is a genetic risk factor for non-cardioembolic stroke in Japan, especially for atherothrombotic brain infarction in women.

ST-segment Elevation Acute Myocardial Infarction in Women in Argentina. Subanalysis of the CONAREC XVII Registry

Introduccion: El infarto agudo de miocardio es una de las principales causas de muerte entre las mujeres. Objetivos: Analizar las caracteristicas del infarto con elevacion del segmento ST en mujeres argentinas. Material y metodos: Estudio observacional, realizado con los datos del registro CONAREC XVII. Resultados: De un total de 694 pacientes, 150 eran mujeres cuya edad media era de 69,2 ± 13,7 anos vs. 59,9 ± 11,5 anos en varones (p = 0,001). Las mujeres presentaron mayor prevalencia de diabetes (29,3% vs. 19,9%, p = 0,010) mientras que el tabaquismo fue mayor en varones (71% vs. 45,3%, p = 0,001). No se hallaron diferencias en sintomas de presentacion, tiempos de isquemia, o tratamientos de reperfusion. Las mujeres tuvieron mayor proporcion de lesion de unico vaso, con mas infartos Killip y Kimbal C-D (15,3% vs. 7,5% (p = 0,001) y mayor requerimiento de inotropicos (21,3% vs. 8,6% (p = 0,001)). Ademas, presentaron significativamente mayor porcentaje de sangrado y de complicaciones mecanicas (4,7% vs. 1,3%, p = 0,017) sin diferencias en el porcentaje de mortalidad. Sin embargo, en el analisis multivariado no se encontro relacion entre el sexo femenino y la mala evolucion hemodinamica o complicaciones. Conclusiones: Las mujeres presentan un perfil de riesgo cardiovascular diferente, con infartos con elevacion del ST con peor impacto hemodinamico y complicaciones intrahospitalarias. El sexo no resulto constituir un elemento individualmente ligado a ello, sino que parece agrupar una serie de factores que implican peor tolerancia al infarto.

Accident vasculaire cérébral ischémique en rapport avec hématome coronaire spontané

Cardiovascular disease in women is a particularly complex pathology especially in the youngest population. The clinical presentation of acute coronary syndromes is sometimes misleading and does not necessarily point to the potential presence of cardiac disease given the frequent absence of cardiovascular risks. Such complexity results in delayed diagnosis, which worsens the outcome of myocardial infarction and generates complications related to the absence of coronary revascularization. We report the case of a patient who suffered an (undiagnosed) apical myocardial infarction that went undetected and was complicated by a voluminous intraventricular thrombus with embolus migration in the cerebral circulation resulting in an ischemic accident. The combination of these two pathologies make their therapeutic management particularly difficult. As widely reported in the literature, the outcome of myocardial infarction in women is poorer than in their male counterparts for a number of reasons. We can assume that in the youngest patients, another physiopathological mechanism is often involved, namely, the occurrence of hematoma and spontaneous coronary dissection. Diagnosis is often difficult even with coronary angiography diagnosis. As shown in the case reported here, initial examination results, if not thoroughly analyzed, may be erroneously interpreted as normal. It is also likely that the presence of hematoma or coronary wall dissection without any plaque rupture may negatively influence the outcome owing to the implementation of inappropriate treatments. In conclusion, in patients presenting with an ischemic cerebral accident, meticulous cardiac examination must be performed even in young women with no cardiovascular risk factors given that the occurrence of hematoma or coronary dissection may contribute to the formation of mural thrombi in the setting of myocardial infarction. Cardiac MRI seems to be particularly effective in the diagnosis of myocardial infarction complicated by the presence of intracavitary thrombi.

Clinical Features and Outcomes of Acute Coronary Syndrome in Women With Previous Pregnancy Complications

BackgroundWomen with previous cardiometabolic complications of pregnancy experience double the risk of cardiovascular disease. However, few data exist on the clinical effect of these complications at the time of an acute coronary syndrome (ACS). The objective of this work was to compare risk factors, clinical features, and outcomes among women with premature ACS with or without previous pregnancy complications (gestational diabetes and/or hypertensive disorders of pregnancy). MethodsData were obtained from a multicentre cohort of individuals hospitalized with premature ACS. A total of 251 parous women were included and provided obstetric history and blood samples. They were followed for the development of major adverse cardiac events at 12 months. ResultsAt presentation with ACS, women with a previous pregnancy complication (38%) were slightly younger than were women without such complications (47.4 ± 6.2 vs 49.1 ± 5.6 years; P = 0.002). They also had more traditional atherosclerotic risk factors. Specifically, women with previous preeclampsia were more likely to have chronic hypertension and an elevated ratio of soluble fms-like tyrosine kinase:placental growth factor. There was no between-group difference in Global Registry of Acute Coronary Events (GRACE) score or troponin tertile but there was a trend toward higher risk of ST-elevation myocardial infarction in women who had a previous pregnancy complication (odds ratio, 1.80; 95% confidence interval, 1.00-3.23; P = 0.05). There was also an increased risk of recurrent ACS at 12 months in women with previous preeclampsia (hazard ratio, 6.79; 95% confidence interval, 1.37-33.63; P = 0.02). ConclusionsAmong a cohort of women with ACS, previous pregnancy complications were associated with more severe disease and poorer outcome.

Unique Presentations and Etiologies of Myocardial Infarction in Women.

Despite recent efforts to reduce cardiovascular disease, it remains the leading cause of morbidity and mortality among women, particularly younger women. When compared to men, women have more inpatient complications, mortality, heart failure, and stroke following acute myocardial infarction (AMI) despite having less obstructive coronary artery disease. Moreover, women are less likely to have AMI from plaque rupture than men, and more likely to experience alternate etiologies of AMI including plaque erosion and spontaneous coronary artery dissection. Herein, we discuss current knowledge regarding women's unique experience of AMI, including demographics, presentation, etiologies, and acute and outpatient care.

ANGIOGRAPHIC HEALING OF SPONTANEOUS CORONARY ARTERY DISSECTION

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon yet important cause of myocardial infarction in women. Very little is understood about the characteristics of angiographic healing and the time-interval for healing of the affected artery. Methods: Patients with SCAD who were

Abstract 166: Female Gender Disparity Observed in STEMI System Time Performance Metrics

Background: We suspect female disparities exist in STEMI system time performance metrics. Reducing time sensitive steps in STEMI care reduces time to reperfusion and improves outcomes. A recent AHA statement on acute myocardial infarction in women reports a need for more data on gender differences in STEMI care. In response, we sought to add to the body of knowledge on this subject by examining and sharing gender specific time performance data from 2 large rural STEMI systems of care. Methods: Data was combined, and retrospectively analyzed for female gender disparities by examining STEMI activation cases from 2 large rural mid-west STEMI systems of care. The Primary Percutaneous Coronary Intervention (PPCI) capable hospitals are located in Duluth, Minnesota, and Fargo, North Dakota. We evaluated 636 consecutive cases from May 2013 through March 2016, and organized them into 3 different settings: PPCI capable hospital emergency departments, non-PCI capable facilities that transfer for PPCI, and EMS field activations transported to a PPCI capable hospital. Findings: Upon evaluation of all cases, 73% were male, and 27% were female. We found 12 STEMI performance metrics showing longer times for females compared to males, and 5 were statistically significant. These times include: door to ECG time in a PCI capable hospital (7 vs 5 min, p=0.027), patient time spent in the ED of a PPCI capable hospital (46 vs. 43 min, p=0.022), door to ECG in a Non-PCI capable hospital (7 vs 6 min, p=0.030), Non-PCI hospital call until EMS arrival to transport the patient (25 vs 16 min, p=0.037), and symptom onset to 911 call when EMS activates STEMI Alert from the field (45 vs 30 min, p=0.013). Conclusion: We report data on 12 common STEMI System time performance metrics, which appear to take longer with females, of which 5 were statistically significant. The reasons for these differences are unknown. Further research and education of gender disparities in STEMI system time performance metrics appears warranted.

Cardiac rehabilitation: where are all the women?

Cardiac rehabilitation is a cost-effective, life-enhancing and lifesaving treatment for patients recovering from cardiac illness. However, certain patient groups are not attending these programmes, including women. While the National Service Framework set a target that 85% of eligible patients should be invited to join cardiac rehabilitation programmes, this target is far from being met—only 30% of eligible women are being invited, while attendance among men is 52%. Progress has been made in the diagnosis of myocardial infarction in women; the use of the high-sensitivity troponin I assay with gender-specific diagnostic thresholds increased the diagnosis rate in suspected cases from 11% to 22%. Despite this, women are less likely to join a cardiac rehabilitation programme than men, who are nearly twice as likely to attend. Women who are older, as well as those with greater comorbidity, higher levels of depression, lower initial exercise capacity, and less social support tended to be less likely to attend. A dislike of the exercise programme, and family obligations, can also reduce attendance. Practitioner endorsement of cardiac rehabilitation alongside advances in technology help to overcome some common barriers to women attending. More creative and dynamic ways need to be found to overcome these constraints to ensure that all those who are likely to benefit from these programmes do so.

Risk Factors for Myocardial Infarction in Women and Men: A Review of the Current Literature.

Cardiovascular disease has been the leading cause of death in both sexes in developed countries for decades. In general, men and women share the same cardiovascular risk factors. However, in recent trials including both men and women sexspecific analyses have raised awareness of sex differences in cardiovascular risk factors due to both biological and cultural differences. Women experience their first myocardial infarction (MI) 6-10 years later than men and a protective effect of their natural estrogen status prior to menopause has been suggested. Female sex hormones have been associated with a less atherogenic lipid profile and a more healthy fat distribution. These differences are attenuated following menopause. Regarding life style the prevalence of smoking is highest in men but female smokers have a relatively higher cardiovascular risk than male smokers. Men are more physically active than women while women have healthier dietary habits. Genetic factors also affect cardiovascular risk but no sex differences have been seen. Increased cardiovascular risk attributed to psychosocial distress is similar in men and women, but since women are more prone to psychosocial distress their burden of disease is greater. Compared with a healthy population the relative risk of MI in a diabetic population is higher in women than in men. No sex difference exists in the prevalence of hypertension but it has an earlier onset in men. Sex differences in cardiovascular risk are becoming more apparent and paying attention to this is pivotal when addressing risk factors in preventive efforts.