scholarly journals Sex disparities in the presentation, management and outcomes of patients with acute coronary syndrome: insights from the ACS QUIK trial

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001470
Author(s):  
Haitham Khraishah ◽  
Barrak Alahmad ◽  
Abdulhamied Alfaddagh ◽  
Sun Young Jeong ◽  
Njambi Mathenge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Sex Differences ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Adjusted Relative Risk ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Coronary Syndrome ◽  
To Receive

AimsOur aim was to explore sex differences and inequalities in terms of medical management and cardiovascular disease (CVD) outcomes in a low/middle-income country (LMIC), where reports are scarce.MethodsWe examined sex differences in presentation, management and clinical outcomes in 21 374 patients presenting with acute coronary syndrome (ACS) in Kerala, India enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACEs) defined as composite of death, reinfarction, stroke and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing women with men, and adjusted for clustering by centre and for age, CVD risk factors and cardiac presentation.ResultsA total of 5191 (24.3%) patients were women. Compared with men, women presenting with ACS were older (65±12 vs 58±12 years; p<0.001), more likely to have hypertension and diabetes. They also had longer symptom onset to hospital presentation time (median, 300 vs 238 min; p<0.001) and were less likely to receive primary percutaneous coronary intervention for ST-elevation myocardial infarction (45.9% vs 49.8% of men, p<0.001). After adjustment, women were more likely to experience in-hospital (adjusted relative risk (RR)=1.53; 95% CI 1.32 to 1.77; p<0.001) and 30-day MACE (adjusted RR=1.39; 95% CI 1.23 to 1.57, p<0.001).ConclusionWomen presenting with ACS in Kerala, India had greater burden of CVD risk factors, including hypertension and diabetes mellitus, longer delays in presentation, and were less likely to receive guideline-directed management. Women also had worse in-hospital and 30-day outcomes. Further efforts are needed to understand and reduce cardiovascular care disparities between men and women in LMICs.

scholarly journals Patient Characteristics, Risk Factors, and Disease Outcomes in Young Adults With St-Elevation Myocardial Infarction: Insights From The Kermanshah Acute Coronary Syndrome Registry

2021 ◽  
Author(s):  
Soraya Siabani ◽  
Leila Gholizadeh ◽  
Hossein Siabani ◽  
Nahid Saleh
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Density Lipoprotein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Younger Adults ◽  
Coronary Syndrome ◽  
Disease Outcomes ◽  
St Elevation

Abstract Background: Myocardial infarction in younger adults is an understudied research area. Objectives: This paper reports on characteristics, risk factors, and disease outcomes of young adults with St-elevation myocardial infarction (STEMI).Methods: This is a sub-analysis of data from the Kermanshah Acute Coronary Syndrome Registry, including all patients aged ≤45 with STEMI (n=247) registered in the registry from June 2017 to June 2019. Results: Patients aged ≤45 constituted 10.66% of all patients with STEM; the majority was male (91.8%), and the most common CVD risk factors included: smoking (56.7%), low high-density lipoprotein (55.5%), elevated triglyceride (44.4%), hypertension (38.2%), hypercholesterolemia (38.1%), elevated low-density lipoprotein (26.3%), and obesity (24.3%). Many patients (62.8%) received primary percutaneous coronary intervention (PCI), and in-hospital mortality was low at 0.8%. Conclusions: Younger adults should be screened for CVD risk factors, and are educated and supported to participate in programs that aim to reduce risk through risk factor modification.

scholarly journals Acute Coronary Syndrome in Malaysian Octogenarian: Trends in Demographics and In-Hospital Managements

2021 ◽  
Author(s):  
Siti Zaleha Suki ◽  
Ahmad Syadi Mahmood Zuhdi ◽  
Abqariyah Yahya ◽  
Nur Lisa Zaharan
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Disease Risk ◽  
Angiotensin Receptor Blockers ◽  
Coronary Intervention ◽  
Evidence Based ◽  
Age Group ◽  
Converting Enzyme Inhibitors ◽  
Coronary Syndrome ◽  
To Receive

Abstract Background: Octogenarians have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS).Method: This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Patients ≥ 80 years old admitted with ACS at 23 participating hospitals from 2008 to 2017 (n=3,080) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies were examined. Binary logistic regression was used.Results: Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (53% men, mean age=83.3, SD±3.4) within the 10-year. The largest ethnic group was Chinese (44%). Hypertension (78%) was the main CV risk factor. Most octogenarians (90.4%) have multiple CV risk factors. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p<0.001). Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p<0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less than half were prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blocker (43.0%). From 2008 until 2017, there were positive increments in cardiovascular intervention and pharmacotherapies. Men were more likely to receive PCI than women (Odds Ratio (OR): 0.698; 95%CI: 0.490-0.993). Those with NSTEMI (OR=0.402, 95% CI: 0.278-0.583) and unstable angina (UA) (OR=0.229, 95% CI: 0.143-0.366 were less likely to receive PCI but more likely to be given anticoagulants (NSTEMI, OR=1.543, 95% CI: 1.111-2.142; UA, OR=1.610, 95% CI: 1.120-2.314) than STEMI octogenarians. The presence of cardiovascular risk factors and comorbidities influences management. For example, those with congestive heart failure were more likely to be given PCI and evidence-based pharmacotherapies.Conclusion: Despite being the most vulnerable age group, octogenarians were conservatively treated with evidence-based treatment of ACS. As it is expected that the number of octogenarians with ACS will continue to increase thus the country needs to prepare to improve the management of this specific group of patients.

Abstract 16825: Indigenous Australians Present 9 Years Earlier With Acute Coronary Syndrome With Worse 12 Months Outcomes; A 14-year Registry Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Vahid Moosavi ◽  
Souvik K Das ◽  
thomas harvey ◽  
Paul Marley ◽  
Ahmad Farshid
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Indigenous Australians ◽  
Indigenous Australian ◽  
Risk Factor Management ◽  
Coronary Syndrome

Introduction: Indigenous Australians have a higher cardiovascular burden than non-indigenous persons. Whether this is associated with more prevalent cardiovascular risk factors or other reasons is not well defined. Hypothesis: Indigenous Australians with acute coronary syndrome (ACS) have more cardiovascular risk factors than non-indigenous Australians. Methods: We performed a retrospective analysis of our ACS registry comparing indigenous and non-indigenous Australian patients who presented with ACS and underwent percutaneous coronary intervention (PCI) between 2006-2019. Results: We treated 9436 patients and 239 (2.4%) were indigenous Australians. On average, Indigenous patients presented 9 years earlier (mean age 55 v 64 years, p<0.0001). In indigenous Australian patients, 32% were under 50 compared with 13% in non-indigenous group (p<0.0001). Comparing the prevalence of traditional cardiovascular risk factors between indigenous Australians and non-indigenous patients, diabetes mellitus (27% v 21%, p=0.016), hypertension (61% v 53%, p=0.028), smoking (54% v 24%, p<0.0001), family history of IHD (43% v 32%, pp=0.0009) and obesity with BMI>30 (46% v 33%, p=0.0001) were higher amongst the indigenous Australians while prevalence of dyslipidemia was similar between the two groups (45% v 46%, p=0.79). Indigenous Australian patients with ACS had worse outcome including higher incidence of acute myocardial infarction within 12 months (11.3% v 4.6% p<0.0001), stent thrombosis (2.51% v 1.06%, p=0.03) and major adverse cardiovascular events (23.8% v 17.2%, p=0.01); however, 12 months mortality (11.7% v 8.7%, p=0.12) was not statistically different between the two groups. Conclusions: Indigenous Australians present with ACS 9 years earlier than non-indigenous patients. This is largely explained by significantly higher prevalence of major cardiovascular risk factors. Moreover, Indigenous Australians had higher MACE rates. Closer attention to risk factor management is required in indigenous Australians for primary and secondary prevention.

scholarly journals Risk factors for major adverse cardiovascular events after the first acute coronary syndrome

2021 ◽  
Vol 53 (1) ◽  
pp. 817-823
Author(s):  
Marjo Okkonen ◽  
Aki S. Havulinna ◽  
Olavi Ukkola ◽  
Heikki Huikuri ◽  
Arto Pietilä ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome

Abstract 16660: Gender Disparities in the Presentation, Management and Outcomes of Patients With Acute Coronary Syndrome: Insights From the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Haitham Khraishah ◽  
Sun Young Jeong ◽  
barrak alahmad ◽  
Abdulhamied Alfaddagh ◽  
Njambi Mathenge ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Sex Differences ◽  
Delayed Presentation ◽  
Cvd Risk ◽  
Middle Income ◽  
Variable Effect ◽  
Random Effects Models ◽  
Killip Class ◽  
Coronary Syndrome ◽  
Relative Risks

Introduction: Despite the increasing interest in sex differences in acute coronary syndrome (ACS) presentation, management, and outcomes in high-income countries, reports on such differences from low- and middle-income countries (LMICs) are limited. Limited resources in LMICs may worsen health disparities experienced by women and vulnerable populations. Methods: Using ACS QUIK trial database, we examined sex-differences in terms of baseline characteristics, management received, and relevant clinical outcomes of 21,374 patients presenting with ACS. The main outcomes were the rates of in-hospital and 30-day composite of death, reinfarction, stroke, and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing females to males. We used random intercepts for different hospitals and centers as the clustering variable. Effect measure modification by baseline variables was examined by restricting the analysis to each category and comparing the effect estimates for females to males. Results: A total of 5,191 (24.3%) patients were women. Compared to men, women presenting with ACS were older (65±12 vs 58±12 years; p < 0.001), more likely to have hypertension (61.2% vs 42.4%; p < 0.001), and diabetes mellitus (53.5% vs 41.4%; p < 0.001). After symptom onset, women tended to present later to the hospital (medians, 300 vs 238 mins; p < 0.001) and had higher Killip class on presentation (17.8% vs 12.3%; p < 0.001). Women presenting with STEMI were less likely to receive primary PCI (45.9% vs 49.8% of men, p <0.001) and had longer median door-to-balloon times (medians, 90 vs 80 mins for men; p <0.001). Compared to men, women were 53% more likely to experience in-hospital MACE (adjusted RR = 1.53; 95% CI, 1.32-1.77; p<0.001), and 39% higher risk of 30-day MACE (adjusted RR = 1.39; 95% CI, 1.65-2.07, p <0.001). Conclusion: In summary, our study confirms a higher CVD risk profile, delayed presentation, suboptimal medical care in women presenting with ACS in Kerala, India. Women were also found to have higher in-hospital and 30-day MACE, even after adjustment for potential confounders.

scholarly journals Gender Differences in Clinical, Angiographic and Procedural Profiles between Young Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 10 (2) ◽  
pp. 113-120
Author(s):  
Fathima Aaysha Cader ◽  
Afzalur Rahman ◽  
Mohammad Ullah ◽  
Mohammad Arifur Rahman ◽  
Md Sarwar Alam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Young Women ◽  
Young Patients ◽  
Coronary Intervention ◽  
Young Males ◽  
Young Females ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: Acute coronary syndrome (ACS) is increasingly prevalent among young patients, particularly in South Asia, where young patients are known to present with multiple risk factors and gender-based differences in angiographic profiles. This study aimed to compare gender differences in clinical, angiographic and procedural profiles between young patients with ACS undergoing percutaneous coronary intervention (PCI).Methods: This prospective observational study was done at the National Institute of Cardiovascular Diseases (NICVD) from April 2016 to March 2017. 190 young patients with ACS undergoing PCI were included. Clinical, angiographic and procedural variables were compared and statistically analyzed.Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively (p<<0.001). Young women had significantly more risk factors of hypertension (62.1% vs 33.7%, p<0.001) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Smoking was significantly greater among young males (70.5% vs 0%, p<0.001). Young females had significantly better mean ejection fraction (EF) (48.4±9.3% vs 45.1±10.4%, p=0. 02). Left main coronary artery (3.2% vs. 1.1%, p=0.61) and left anterior descending artery (51.6% vs. 45.3%, p=0.38) were more frequently involved among young females. Young males showed angiographically more severe CAD and greater frequency of multivessel CAD with higher DVD (22.1%vs 18.9%, p=0.58) and TVD (18.9%vs 11.6%, p=0.15).Conclusion: Significantly more young women with ACS presented with hypertension and diabetes than young males. However, they had better ejection fraction and less severe angiographic profiles.Cardiovasc. j. 2018; 10(2): 113-120

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