TY - JOUR
T1 - Clinical presentation, quality of care, risk factors and outcomes in women with acute ST-elevation myocardial infarction (STEMI)
T2 - An observational report from six middle eastern countries
AU - Shehab, Abdulla
AU - Alhabib, Khalid F.
AU - Bhagavathula, Akshaya S.
AU - Hersi, Ahmad
AU - Alfaleh, Hussam
AU - Alshamiri, Mostafa Q.
AU - Ullah, Anhar
AU - Sulaiman, Khadim
AU - Almahmeed, Wael
AU - Al Suwaidi, Jassim
AU - Alsheikh-Ali, Alwai A.
AU - Amin, Haitham
AU - Al Jarallah, Mohammed
AU - Salam, Amar M.
N1 - Funding Information:
The study was mainly funded by AstraZeneca, and partially by the Saudi Heart Association, the College of Medicine Research Centre at King Khalid University Hospital, and the Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG-1436-013. The funders had no role in study design, data collection, and analysis or preparing the manuscript.
Publisher Copyright:
© 2019 Bentham Science Publishers.
PY - 2019
Y1 - 2019
N2 - Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When throm-bolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher in-hospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
AB - Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When throm-bolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher in-hospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
KW - Acute coronary syndrome
KW - Middle-East
KW - Mortality
KW - Percutaneous coronary intervention
KW - Quality of care
KW - ST-elevated myocardial infraction
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U2 - 10.2174/1570161116666180315104820
DO - 10.2174/1570161116666180315104820
M3 - Article
C2 - 29542414
AN - SCOPUS:85065980169
SN - 1570-1611
VL - 17
SP - 388
EP - 395
JO - Current Vascular Pharmacology
JF - Current Vascular Pharmacology
IS - 4
ER -