Reduced quality of life after myocardial infarction in women compared with men

BACKGROUND: Psychosocial factors have been suggested as risk factors for atherosclerotic disease. HYPOTHESIS: The purpose of the present study was to examine whether there is a gender difference in quality of life after a myocardial infarction with modem treatment of acute ischemic heart disease. METHODS: In all, 123 men and women aged between 31 and 80 years, and with a hospital-diagnosed myocardial infarction occurring 1-12 months prior to inclusion, were studied. Minor symptoms evaluation profile (MSEP) was used to estimate quality of life at entry. RESULTS: Age, hemodynamic data, smoking habits, as well as laboratory data, concomitant cardiovascular disease, and revascularization rate did not differ between men and women. Women had significantly more negative feelings regarding all the estimated dimensions of quality of life (Contentment, Vitality, and Sleep) than did men. CONCLUSION: Self-assessed quality of life after a myocardial infarction was significantly lower among women than among men despite similar age, treatment, and hemodynamic and laboratory data. The causal relationship is however, not known. Further studies are needed to evaluate the underlying mechanism of this observation. This may lead to the development of novel treatment strategies in female patients after a myocardial infarction.     

Increased plasma thioredoxin in patients with acute myocardial infarction

BACKGROUND AND HYPOTHESIS: Thioredoxin is an important biomarker for oxidative stress. We investigated whether thioredoxin levels were elevated in patients with acute myocardial infarction (AMI) and were associated with the results of coronary reperfusion. METHODS: The present study determined plasma thioredoxin levels in 51 patients with AMI, 30 patients with stable exertional angina (SEA), and 30 patients with chest pain syndrome (CPS). Plasma sampling was performed on admission, at 12 h, 1 week, 2 weeks, and 4 weeks in patients with AMI, and after admission in patients with SEA and CPS. RESULTS: Plasma thioredoxin levels on admission were higher in patients with AMI than in those with SEA and CPS. Plasma thioredoxin levels in patients with AMI were decreased in 12 h without further change thereafter. However, thioredoxin levels in patients with AMI remained higher than in those with SEA. In multivariate analysis, higher levels of thioredoxin on admission were a risk factor for failure in emergent reperfusion therapy in patients with AMI independent of other factors. CONCLUSION: Plasma thioredoxin levels are elevated in patients with AMI, and higher thioredoxin levels may predict subsequent failed coronary reperfusion therapy in patients with AMI.     

Differences in thrombolytic treatment and in-hospital mortality between women and men after acute myocardial infarction

There is evidence for gender differences in the treatment and outcome of acute myocardial infarction (AMI). However, little data exist about these differences in patients from the Arab Middle East. Therefore, we studied the influence of patient gender on the presentation, the use of thrombolytic therapy, and in-hospital mortality after AMI in Kuwaiti nationals. This is a retrospective study of all consecutive Kuwaiti patients admitted to the coronary care unit of a university hospital with the diagnosis of AMI between June 1994 and May 1997. A total of 89 women and 267 men were included. Women were older than men and had significantly higher rates of diabetes (72% vs 46%), hypertension (58% vs 33%) and hypercholesterolemia (80% vs 53%). Women were less likely to receive thrombolytic therapy (40% vs 62%, p=0.001). Fewer women were eligible for thrombolytic therapy (50% vs 66%, p<0.05). Of those who were eligible for thrombolysis there was no sex difference in receiving such treatment. The in-hospital mortality among women younger than 70 years was 2.5 times higher than among men in the same age group, while there was no difference in mortality between women and men aged 70 years and older. We conclude that women and men with AMI have different clinical characteristics and outcomes following AMI. There was no gender bias for the use of thrombolytic therapy. The higher in-hospital mortality in younger women, i.e. less than 70 years, compared to younger men, indicates that younger women with AMI should be considered as a high-risk group.     

影响急性心肌梗死患者住院病死率的因素

目的 探讨影响急性心肌梗死（AMI）患者住院病死率的因素。方法 回顾分析AMI患者2 136例,比较出院时存活和住院期间死亡两组患者的临床特征和住院治疗,并应用Logistic回归分析筛选影响AMI患者住院病死率的因素。结果 与存活组相比,死亡组患者年龄较大［(71±10)岁 vs （62±11）岁,P<0.01］,男性和有吸烟史者较少（56.0% vs 71.5%,P<0.01;45.2% vs 54.2%,P<0.05）,高血压病、糖尿病和高脂血症患病率较高（分别为58.3% vs 43.2%,47.7% vs 21.1%,72.0% vs 58.8%,均P<0.01）,心功能Killip分级较高（2.0±1.1 vs 1.2±0.5,P<0.01）,急性期再灌注治疗率和住院期间β受体阻滞剂及硝酸酯类药物的使用率较低（分别为10.1% vs 30.3%,47.0% vs 71.1%,95.2% vs 98.6%,均P<0.01）。Logistic回归分析显示年龄、高血压病、糖尿病、高脂血症、心功能Killip分级、再灌注治疗、β受体阻滞剂和硝酸酯类药物的使用率为影响AMI患者住院病死率的独立危险因素。结论 年龄、高血压病、糖尿病、高脂血症、心功能Killip分级、再灌注治疗、β受体阻滞剂和硝酸酯类药物的使用率对AMI患者住院病死率有显著影响。     

Fatal outcome of acute myocardial infarction in men and women

An epidemiologic study of the outcomes of acute myocardial infarction, carried out according to the WHO Register of Acute Myocardial Infarction, demonstrated that overall mortality rates are similar for men and women between 20 and 69 years of age. Prehospital mortality was significantly higher in men, as compared to women, while the opposite was true for hospital mortality. Overall, prehospital and hospital mortality rates were relatively high in the younger patients, both male and female, an evidence of a more severe course of acute myocardial infarction at a younger age.     

Comparison of mortality rates in women versus men presenting with ST-segment elevation myocardial infarction

Women who present with coronary artery disease have different characteristics, undergo different treatment, and have a different prognosis than men. The increasing use of coronary stenting has improved the outcome of percutaneous coronary intervention (PCI). However, little is known about the outcomes for men versus women after PCI, especially for those presenting with a diagnosis of acute coronary syndrome. Thus, we compared the baseline features, management, and long-term outlook of men versus women undergoing PCI. All consecutive patients who had undergone PCI with stents at our center from July 1, 2002 to June 30, 2004 were identified retrospectively. The primary end point was the long-term rate of major adverse cardiac events (i.e., death, infarction, and repeat revascularization). The secondary end points were the individual components of the major adverse cardiac events and stent thrombosis. A total of 833 patients were included, 210 women (25.2%) and 623 men (75.8%). The women were significantly older (70.9 vs 63 years, p <0.001) and more often had diabetes mellitus (36.2% vs 21.0%, p <0.001) and hypertension (82.3% vs 73.7%, p = 0.006). The number of drug-eluting stents and the length were significantly lower in the female patients. The incidence of major adverse cardiac events after a median follow-up of 60 months was similar for both women and men (38.8% vs 46.4%, p = 0.075), with a trend toward greater mortality rate for women (21.2% vs 15.4%, p = 0.090). All other end points occurred with similar frequencies. Only in the subgroup of ST-segment elevation myocardial infarction were the rates of death significantly greater for the women than for the men (20.0% vs 8.1%; p = 0.029). In conclusion, very long-term follow-up of women undergoing PCI with coronary artery stenting resulted in similar rates of cardiac event compared to those of men, but greater care should be given to women presenting with ST-segment elevation myocardial infarction. Also, despite their greater baseline risk profile, women were significantly less likely to have received effective treatment, the use of including drug-eluting stents.     

Comparison of management and 30-day mortality of acute myocardial infarction in men versus women in Estonia

OBJECTIVE: There is conflicting information about gender differences in clinical features, management and outcome after acute myocardial infarction (AMI). The objective of the study was to compare the baseline characteristics, management and 30-day mortality of AMI in men and women in Estonia. METHODS: This study included consecutive unselected patients from the Myocardial Infarction Registry (MIR) in Estonia, who were admitted to a university hospital between January 2001 and February 2002. Logistic regression analysis was used to estimate crude and adjusted odds ratios (OR) with 95 percent confidence intervals (95% CI). RESULTS: The study included 228 men and 167 women. Women were older than men (73.49 +/- 10.95 vs. 65.63 +/- 12.60, p < 0.000), and had more comorbidities. After age-adjustment, the higher prevalence of comorbidities, like diabetes (age-adjusted odds ratio [OR] 2.48, 95% confidence intervals [CI] 1.45-4.24), hypertension (OR 1.78, 95% CI 1.15-2.76) and history of congestive heart failure (OR 2.14, 95% CI 1.32-3.46) in women was preserved. Women were more frequently treated with diuretics (OR 2.68, 95% CI 1.69-4.25) and less frequently with statins (OR 0.61, 95% CI 0.39-0.96), after age-adjustment. Although thrombolytic therapy, coronary angiography and angioplasty were performed less frequently in women, these differences disappeared after age-adjustment. Female gender was not an independent predictor of 30-day mortality after AMI, crude OR was 1.39, 95% CI 0.80 to 2.41, adjustment for age and other covariates reduced OR to 0.98, 95% CI 0.44 to 2.20. CONCLUSIONS: Among AMI-patients, age but not gender is an important determinant of care and early mortality.     

Increased tissue factor pathway inhibitor in patients with acute myocardial infarction

We examined hemostatic abnormalities in 23 patients with acute myocardial infarction (AMI), 10 with pulmonary embolism (PE), and 10 with deep vein thrombosis (DVT). At the onset of AMI, plasma levels of tissue-type plasminogen activator (t-PA), PA inhibitor-I (PAI-I), fibrin-D-dimer, thrombin-antithrombin complex (TAT), and plasmin-plasmin inhibitor complex (PPIC) were significantly increased. Both the plasma total TFPI and free-TFPI levels in the AMI patients were significantly higher than those in the healthy volunteers, PE patients, and DVT patients. There was no significant difference in total TFPI or free-TFPI among patients with PE, those with DVT, and healthy volunteers. One hour after percutaneous transluminal coronary angioplasty (PTCA) in the AMI group, the total TFPI level was further increased, and it was significantly reduced 24 hr after PTCA, to a level similar to that in healthy volunteers. Free-TFPI showed a pattern similar to that of total TFPI. The ratio of free-TFPI/total TFPI was highest 1 hr after PTCA. Increased TFPI in AMI patients might be released from ischemic tissues. Am. J. Hematol. 55:183–187, 1997. © 1997 Wiley-Liss, Inc.     

急性心肌梗死发病至就诊时间与预后的关系

目的分析580例急性心肌梗死（AMI）患者院前延误时间分布及心肌梗死后不同时间段的死亡情况。方法回顾性分析2004年3月至2006年3月北京安贞医院抢救中心急诊室和急诊重症监护室收治的AMI患者580例,其中男性428例,女性152例,平均年龄（60．7±12．9）岁。将记录的就诊时间与发病时间的时间差作为院前延误时间（PDT）。根据PDT不同分为7个时间段：即1～30min,31～60min,61～120min,121～240min,241～360min,361～720min,〉720min。为琶计PDT分布,计算各时间段心室颤动（室颤）发生率、复苏成功率、病死率,并对不同时间段死亡原因相关因素进行分析。结果580例AMI患者PDT中位数时间为130min。接受溶栓治疗122例（21．0％）,急诊PCI及冠状动脉搭桥术（CABG）266例（45．9％）,其他药物对症治疗192例（33．1％）;比较三组PDT,溶栓组[（104．5±2．3）min]和PCI／CAB（;组[（119．1±2．3）min]均低于其他药物治疗组[（290．9±3．4）min,P〈0．05]。发生室颤46例（7．9％）,其中PDT≤30min24．4％（11／45）,31～60min7．7％（8／104）,61～120min10．3％（14／136）,121～240min6．6％（8／121）,241～360min1．9％（1／54）,361～720min3．3％（2／61）,〉720min3．4％（2／59）;复苏成功率71．7％（33／46）,总病死率5．3％。年龄（OR=1．047,P=0．004）、糖尿病（OR=2．159,P=0．02）和PDT（OR=2．159,P=0．023）是影响患者预后的独立相关因素。结论缩短PDT,及早进入治疗程序,挽救濒死心肌,对预防室颤、猝死发生,降低病死率至关重要。     

Variation in hospital mortality rates for patients with acute myocardial infarction

Hospitals vary by twofold in their hospital-specific 30-day risk-stratified mortality rates (RSMRs) for Medicare beneficiaries with acute myocardial infarction (AMI). However, we lack a comprehensive investigation of hospital characteristics associated with 30-day RSMRs and the degree to which the variation in 30-day RSMRs is accounted for by these characteristics, including the socioeconomic status (SES) profile of hospital patient populations. We conducted a cross-sectional national study of hospitals with ≥15 AMI discharges from July 1, 2005 to June 20, 2008. We estimated a multivariable weighted regression using Medicare claims data for hospital-specific 30-day RSMRs, American Hospital Association Survey of Hospitals for hospital characteristics, and the United States Census data reported by Neilsen Claritas, Inc., for zip-code level estimates of SES status. Analysis included 2,908 hospitals with 513,202 AMI discharges. Mean hospital 30-day RSMR was 16.5% (SD 1.7 percentage points). Our multivariable model explained 17.1% of the variation in hospital-specific 30-day RSMRs. Teaching status, number of hospital beds, AMI volume, cardiac facilities available, urban/rural location, geographic region, ownership type, and SES profile of patients were significantly (p < 0.05) associated with 30-day RSMRs. In conclusion, substantial variation in hospital outcomes for patients with AMI remains unexplained by measurements of hospital characteristics including SES patient profile.     

急性心肌梗死近20年住院临床诊治和病死率的比较分析

目的了解本院20年间急性心肌梗死（AMI）的病死率及其影响因素的改变。方法对我院1980-1983年134例、1990-1993年354例和2000-2003年817例急性心肌梗死患者的资料进行比较分析。结果住院病死率从1980-1983年的22．4％降至1990-1993年的14．4％直至2000-2003年的9．2％（P〈0．01）。男性患者病死率降低明显（P〈0．01）。有利于病死率降低的因素有：年龄〈60岁,初发心肌梗死,心脏骤停的抢救成功率和血管再灌注治疗。不利因素为女性。结论20年间的AMI药物治疗内容及血管再灌注治疗的进展,致使AMI住院病死率的明显下降。     

Increased mortality rate in diabetic rats submitted to acute experimental myocardial infarction

Diabetes mellitus is well known to increase the death rate after acute myocardial infarction in humans. The mechanisms of this adverse effect of diabetes, however, remain unknown. In the present study an animal model was developed in which the influence of diabetes on the survival rate after acute myocardial infarction could be studied in more detail. Male Wistar rats were rendered diabetic with streptozotocin (45 mg X kg-1 intravenously) and kept in the study if one week later their tail blood glucose concentration was between 13.9 and 22.2 mmol X litre-1 after a four hour fast. Ten weeks later they underwent acute left coronary artery ligation. In comparison with control rats (n = 30), diabetic rats (n = 32) had a higher mortality in the first 20 minutes after acute coronary artery ligation (78% vs 53%; p less than 0.05 by chi 2 test). Creatine kinase-MB isoenzyme activity tended to increase less in surviving diabetic rats than in their non-diabetic counterparts. Moreover, blood samples collected a few minutes before the surgical procedure showed that diabetic rats dying within the first 20 minutes (n = 25) had higher mean (SEM) plasma glucose concentrations (26.9(0.5) vs 23.4(1.2) mmol X litre-1; p less than 0.01) and lower mean(SEM) plasma insulin concentrations (20(1) vs 26(2) mU X litre-1; p less than 0.05) than those (n = 7) that survived that critical period.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年急性心肌梗死患者白细胞计数与心脏功能及在院死亡率的关系

目的探讨老年ST段抬高急性心肌梗死(STEAMI)患者外周血白细胞(WBC)计数与住院期间心功能和在院死亡率的关系。方法686例STEAMI患者查血常规后,分为高白细胞组(WBC>10×109/L)和正常白细胞组(WBC<10×109/L),观察住院期间的死亡情况,其中476例检查二维超声心动图。结果高白细胞组的死亡率和心衰(Killip分级)发生率明显高于正常白细胞组。高白细胞组的射血分数(EF)和左室短轴缩短率(FS)均低于正常白细胞组。溶栓后临床指标再通患者高白细胞组EF明显低于正常白细胞组,而补救PCI患者高白细胞组EF、FS与正常白细胞组无统计学差异。相关分析发现,WBC计数与EF和FS呈负相关。结论老年STEAMI患者WBC计数与心功能呈负相关,WBC升高是心衰和死亡率增加的预测指标。     

Heart rate during myocardial infarction: relationship with one-year global mortality in men and women

BACKGROUND: Elevated heart rate (HR) has been found to be related to an increased death rate in patients with acute myocardial infarction (AMI), but sex differences and optimal timing for HR measurement have not been sufficiently investigated. OBJECTIVES: To verify the predictive value of HR for one-year mortality in a cohort of subjects hospitalized for AMI, with men and women considered separately. PATIENTS AND METHODS: HR was measured in 424 patients (303 men and 121 women) with constant sinus HR, on the first, third and seventh days after hospital admission for AMI. Clinical and laboratory data were obtained on the same days. All patients were followed up for one year. RESULTS: Among the men, the one-year mortality rate was 5% for the subjects with a seven-day HR of less than 80 beats/min, and the one-year mortality rate was 39% for patients with a seven- day HR of 80 beats/min or more (P<0.0001). Among the women, the differences in mortality related to HR were not significant. In a multivariate Cox regression analysis, the relative risks of mortality in men who had an HR of 80 beats/min or more were 3.1 (CI=1.4 to 7.0, P=0.003) on the first day, 4.1 (CI=1.8 to 9.8, P=0.001) on the third day and 8.6 (CI=2.9 to 27.0, P<0.0001) on the seventh day. In the 203 men in whom echocardiographic left ventricular ejection fraction was measured, an interactive effect of high HR with depressed ejection fraction on mortality was found. Beta-blocking therapy influenced HR during AMI but did not influence the HR-mortality association. CONCLUSIONS: The results of the present prospective study show that HR measured during the first week after admission for AMI is an important predictor of mortality in men. The predictive power of HR increased from the first to the seventh day after AMI.