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Medicineworld.org: Survival after myocardial infarction

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Survival after myocardial infarction




A paper published online by the journal Circulation on 8 December 2008 concluded that, while men and women have a similar in-hospital death rate following acute myocardial infarction, women with STEMI had an adjusted mortality rate almost twice as high as men (10.2% versus 5.5%). These differences were linked to a lower likelihood of reperfusion treatment in women. The paper was widely published in the press, with suggestions of disparity in care and outcome after AMI.



Survival after myocardial infarction

This study is one of a number of undertaken in the past 20 years on gender differences in the management of acute coronary events. A number of, like this latest study, have observed that women are treated less intensively in the acute phase. However, after adjustment for age, co-morbidity and severity of disease, some of these disparities have been found to disappear. Similarly, a number of studies have observed gender differences in short-term survival rates after AMI, but such differences have not always persisted in the long term.

In Europe results from a Swedish cohort study of 53,781 subjects (of whom 37 per cent were women) also showed that overall women were less intensively treated than men, but, in cases of non-STEMI, had a better long-term prognosis than men.

Commenting for the ESC on the STEMI results in the Circulation paper, Professor Eva Swahn (University Hospital, Linkping, Sweden), who has conducted gender studies in acute coronary syndrome patients, said: "We are not surprised. We found similar results in our Swedish cohort study".

Eventhough the occurence rate of AMI is low in both sexes, particularly in premenopausal women, the view persists mistakenly that women don't have the same coronary symptoms as men. "This is a myth," says Professor Swahn. "The classical symptoms of AMI are the same for women as for men." However, this mistaken belief may explain why reperfusion treatment is not started as quickly in women as in men because women interpret their symptoms differently from men and may not summon help soon enough.

While there are some recurring patterns in the studies less intensive therapy in women, lower survival rates in female STEMI patients much of the explanation for the disparities remains unknown. Definite answers about medication, invasive or non-invasive therapy, and survival will only be derived from studies powered to draw significant conclusions in both men and women in the same prospective cohort. And the optimal therapy recommendations for men and women respectively will only be resolved by inclusion of sufficient numbers of both women and men in future clinical trials.


Posted by: Daniel    Source




Did you know?
A paper published online by the journal Circulation on 8 December 2008 concluded that, while men and women have a similar in-hospital death rate following acute myocardial infarction, women with STEMI had an adjusted mortality rate almost twice as high as men (10.2% versus 5.5%). These differences were linked to a lower likelihood of reperfusion treatment in women. The paper was widely published in the press, with suggestions of disparity in care and outcome after AMI.

Medicineworld.org: Survival after myocardial infarction

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