Comparison of Men and Women With Acute Coronary Syndrome in Six Middle Eastern Countries

doi:10.1016/j.amjcard.2009.06.003

The American Journal of Cardiology

Volume 104, Issue 8, 15 October 2009, Pages 1018-1022

https://doi.org/10.1016/j.amjcard.2009.06.003 Get rights and content

The aim of this study was to evaluate the gender differences in baseline characteristics, therapy, and outcomes in patients with acute coronary syndromes in 6 Middle Eastern countries. Over a 6-month period in 2007, 8,169 consecutive patients (74% men, 24% women) presenting with acute coronary syndromes were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. Women were 9 years older than men and more likely to have diabetes, hypertension, and dyslipidemia. Women were more likely to present with unstable angina and more often had atypical presentations of ST elevation myocardial infarction. Compared to men, women were significantly less treated with β blockers and antiplatelet therapy, whereas reperfusion therapy was nonsignificantly less used in women. In all patients with acute coronary syndromes, women not only ranked higher on Global Registry of Acute Coronary Events risk score but also had increased in-hospital mortality, 1.75 times that of men. This mortality difference persisted after adjusting for all confounders (odds ratios 1.76, 95% confidence interval 1.1 to 2.8, p <0.01). In conclusion, in addition to presentation with higher risk factors, female gender also independently predicted poorer outcomes in patients with ST elevation myocardial infarction.

Section snippets

Methods

Data were collected from a 6-month prospective, multicenter study of the Gulf Registry of Acute Coronary Events (Gulf RACE) that recruited 8,169 consecutive patients with ACS from 6 adjacent Middle Eastern countries (Bahrain, Kuwait, Qatar, Oman, the United Arab Emirates, and Yemen). Patients were recruited from 64 hospitals with diagnoses of ACS, including unstable angina and ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). On-site cardiac catheterization laboratories were

Results

We enrolled 8,169 patients who were admitted with ACS, and data were successfully completed for 8,166 inpatients (6,183 men and 1983 women); 3 were missing. Women were 9 years older than men and had diabetes, hypertension, obesity, and dyslipidemia more often than men. Smoking was more prevalent in men than in women. Women had more co-morbidities than men. However, there were no significant differences in histories of myocardial infarction or renal impairment between the genders (p = 0.2; Table

Discussion

The present study demonstrated for the first time in a large registry in the Middle East that women with ACS had a higher mortality rate than men after adjustment for all confounders (age, heart rate, diabetes, hypertension, and GRACE risk score). This mortality difference persisted after adjustment in patients with STEMIs. Consistent with previous studies, Gulf RACE showed that women not only had a significantly higher risk for worse in-hospital outcomes, such as reinfarction, heart failure,

Acknowledgment

We would like to thank all the staff at all the participating centers for their invaluable cooperation.

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Clinical Presentation, Risk Factor, and Outcomes of Acute Coronary Syndrome in Women at an Urban Referral Center in Dakar, Senegal
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Cardiovascular disease is on the rise in Sub-Saharan countries. Recently, consistent studies have reported sex differences in the epidemiology of acute coronary syndrome (ACS). Although, data on the incidence of ACS in Sub-Saharan countries are not rare, few focused closely on women.
The purpose of this study was to examine risk factors, clinical presentations, and management strategies in women with ACS.
This was a retrospective study conducted at the Cardiology Department of Principal Hospital of Dakar over a period of 60 months (January 1, 2010, to December 31, 2014), in Dakar, Senegal. Medical records of female subjects admitted for ACS on the basis of anginal pain at rest, suggestive electrocardiographic changes, and elevated troponin I levels were included. We collected and analyzed the epidemiological, clinical, paraclinical, and evolutionary data of the patients.
Hospital prevalence of ACS in women was 2.32%, meaning 38.1% of patients were admitted for ACS during the same period. The mean age of patients was 68.8 ± 9.5 years; 52% of them were aged between 60 and 69 years. The risk factors in our patients were dominated by hypertension found (63.3%) and diabetes (54.1%). Active smoking was found in 6 patients (6.1%). One-half of patients had more than 1 risk factor. Chest pain was present in 94 patients (95.9%).
The average time delay before medical care was administered was 53.9 ± 18 h. Thirty patients showed signs of left ventricular failure (Killip classes I and II). Electrocardiography revealed ACS with persistent ST-segment elevation in 53 patients (54.1%) and non–ST-segment elevation ACS in 45 patients (45.9%). Mean troponin I level was 1.68 ± 2.3 ng/ml. Doppler echocardiography revealed impaired segmental kinetics in more than one-half of patients. The mean ventricular ejection fraction was 43.8 ± 10.1%. Thrombolysis was performed in 10 patients, accounting for 10.2% of patients with ST-segment elevation. The evolution during hospitalization after a mean hospital stay of 9.5 ± 3.7 days was favorable in 66 patients (67.3%). Six deaths (6.1%) were recorded. Complications was dominated by pulmonary edema.
Our study confirms that ACS is not a “man's only” disease in Sub-Saharan countries. The major concern is that there appeared to be continuing evidence of suboptimal treatment and intervention in women with ACS in current practice.
Comparison of the application of treatment Panel III and American College of Cardiology/American heart Association guidelines for blood cholesterol treatment in Saudi Arabia
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One of the major risk factors for cardiovascular diseases is hyperlipidemia. The primary aim of this study was to estimate the proportion of individuals between 40–75 years old that would be eligible for statin therapy based on ACC/AHA guideline as compared to ATP-III guideline in a population of patients in Saudi Arabia. We also intended to extrapolate the results to the entire Saudi population, and estimate the cost implications of the ACC/AHA treatment guideline.
This study was a retrospective, observational study involving adult patients aged between 40-75 years old. The study was conducted at the primary health care clinics at King Abdul-Aziz Medical/Riyadh. The eligibility for statins use was assessed and compared for each patient based on both the recent 2013 ACC-AHA guideline and the 2002 ATP-III guideline. The cost implication of applying the ACC/AHA treatment guideline was estimated based on the average cost for 40 mg Atorvastatin in the Saudi Market.
A total of 1005 patients were included in the study. Using the ATP-III guideline, there were 139 male (43.7%) and 279 female (40.6%) eligible to receive statin therapy. Based on the 2013 ACC/AHA guideline, treatment is recommended in 315 males (99.1%) and 564 females (82.1%). On the other hand, high-intensity statin was recommended in 302 male (95%) and 400 female (58.2%). Only 74 (10.5%) patients were prescribed high-intensity statin of the 702 eligible patients. Extrapolating the results to the entire Saudi population, 2.369 million additional patients would be eligible for statin therapy when applying the ACC/AHA guideline. Applying the new guideline would result in a cost increase of at least 4.318 billion SR per year.
The eligibility for statin therapy was much higher when applying the ACC/AHA guideline as compared to ATP-III guideline. Applying the recent ACC/AHA dyslipidemia guideline increased the number of patients eligible for statin therapy to approximately two folds. This would be associated with a substantial increase in cost and possibly side effects. The concerns surrounding the ACC/AHA guideline should be addressed at the national level.
Prevention of coronary microvascular obstruction by addressing the individual susceptibility
2018, Coronary Microvascular Obstruction in Acute Myocardial Infarction: From Mechanisms to Treatment
Another pathogenetic component of coronary microvascular obstruction (CMVO) is constituted by the individual susceptibility to microvascular dysfunction, probably related to the function, as well as to the structure and the density of the microcirculation. Common and uncommon cardiovascular risk factors can cause a pre-existing transient or permanent microvascular dysfunction, which contributes to the development and prognosis of acute coronary syndrome. Moreover, genetic factors may enhance the individual susceptibility of CMVO, affecting polymorphism of genes responsible of the onset, trigger and/or modulation of coronary microvascular dysfunction, as well as the resistance to the lysis. Finally, ischemic pre-conditioning may determine the individual susceptibility to CMVO, by protecting both the myocardium and the coronary microcirculation. This chapter summarizes the mechanisms, the effects, the prevention, and treatment of the single causes of individual susceptibility to CMVO.
Risk profile and in-hospital prognosis in elderly patients presenting for acute ST-elevation myocardial infarction in the Tunisian context
2016, Indian Heart Journal
Little is known about the risk profile and in-hospital prognosis of elderly patients presenting for ST-elevation myocardial infarction (STEMI) in Tunisia. We sought to determine in-hospital prognosis of elderly patients with STEMI in a Tunisian center.
The study was carried out on a retrospective registry enrolling 1403 patients presenting with STEMI in a Tunisian center between January 1998 and January 2013. Patients ≥75 years old were considered elderly. Risk factors and in-hospital prognosis were compared between elderly and younger patients, and then predictive factors of in-hospital death were determined in elderly patients.
Out of the overall population, 211 (15%) were part of the elderly group. Compared to younger patients, elderly patients were more likely to have arterial hypertension but less likely to be smokers and obese. Thrombolysis was significantly less utilized in the elderly group (22.3% vs. 36.6% in the younger group, p < 0.001), whereas the use primary percutaneous coronary intervention was comparable between the two sub-groups (24.2% vs. 28.8%, p = 0.17). The incidence of in-hospital complications was higher in the elderly group, and so was the in-hospital mortality rate (14.2% vs. 8.1%, p = 0.005). Heart failure on-admission, renal failure on-admission, and inotropic agents use were independently associated to in-hospital death in the elderly group.
In the Tunisian context, elderly patients presenting with STEMI have higher prevalence of risk factors and a worse in-hospital course in comparison to younger patients. Clinical presentation on-admission has a strong impact on in-hospital prognosis.
In-hospital outcomes and long-term mortality according to sex and management strategy in acute myocardial infarction. Insights from the French ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 Registry
2015, International Journal of Cardiology
The early mortality of acute myocardial infarction (AMI) has dramatically decreased in the recent past. Whether the previously reported sex disparities in use of invasive strategies (IS) persist and translate into differences in outcomes deserves to be examined.
We used the data from a nationwide French prospective multicentre registry from 3,670 AMI patients (1155 women (31.5%), 2515 men (68.5%)) recruited in 223 centres in 2005 and followed-up for 5 years. We examined in-hospital outcomes and 5-year mortality in patients categorized according to sex and use of IS (i.e. coronary angiography during the hospitalisation with a view to revascularisation).
IS was less frequently used in women than in men (adjusted OR = 0.66; 95% CI: 0.52–0.85), regardless of the type of AMI, age group or risk category, while use of recommended medications was similar at 48 hours and discharge. In-hospital mortality did not differ according to sex, whatever the age group and use of an IS. At 5 years, overall and post-discharge mortality were similar in men and women. However, IS was associated with lower 5-year mortality in women (HR = 0.66; 95% CI: 0.51–0.86) as in men (HR = 0.48; 95% CI: 0.38–0.60) and there was no sex-strategy interaction.
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NCT 00673036

View all citing articles on Scopus

: The Gulf Registry of Acute Coronary Events is a Gulf Heart Association project and was financially supported by Sanofi-Aventis, Paris France, and Qatar Telecommunications Company, Doha, Qatar.

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Coronary artery diseaseComparison of Men and Women With Acute Coronary Syndrome in Six Middle Eastern Countries

Section snippets

Methods

Results

Discussion

Acknowledgment

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Cardiol Clin

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Rev Esp Cardiol

Am Heart J

J Am Coll Cardiol

Clinical presentation and outcomes of acute coronary syndromes in the gulf registry of acute coronary events (Gulf RACE)

Saudi Med J

Impact of gender in patients with acute coronary syndrome

Expert Rev Cardiovasc Ther

Coronary artery disease
Comparison of Men and Women With Acute Coronary Syndrome in Six Middle Eastern Countries