Abstract 514: Sex-Related Disparities in Outcomes After Myocardial Infarction Among Patients With Atrial Fibrillation: Evidence From a Nationwide Study

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Akintunde M Akinjero ◽  
Oluwole Adegbala ◽  
Tomi Akinyemiju
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Female Gender ◽  
The United States ◽  
Nationwide Study ◽  
Adjusted Risk ◽  
Targeted Interventions ◽  
Significant Difference

Background: The overall mortality rate after acute myocardial infarction (AMI) is falling in the United States. However, outcomes remain unacceptably worse in females compared to males. It is not known how coexisting atrial fibrillation (AF) modify outcomes among the sexes. We sought to examine the association of sex with clinical characteristics and outcomes after AMI among patients with AF. Methods: We accessed the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to extract all hospitalizations between 2007 and 2011 for patients above 18yrs with principal diagnosis of AMI and coexisting diagnosis of AF using ICD 9-CM codes. The NIS represents the largest all-payer hospitalization database in the United States, sampling approximately 8 million hospitalizations per year. We also extracted outcomes data (length of stay (LOS), stroke and in-hospital mortality) after AMI among Patients with AF. We then compared sex differences. Univariate and Multivariate analysis were conducted to determine the presence of statistically significant difference in outcomes between men and women. Results: A total of 184,584 AF patients with AMI were sampled, consisting of 46.82% (86,420) women and 53.13% (98,164) men. Compared with men, women with AF and AMI had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.51, 95% CI=1.45-1.59), and higher in-hospital mortality (aOR=1.12, 95% CI=1.09-1.15). However, female gender was not significantly associated with longer LOS (aOR=-0.22, 95% CI= -0.29-(-0.14). Conclusion: In this large nationwide study of a population-based cohort, women experienced worse outcomes after AMI among patients with AF. They had higher in-hospital mortality and increased stroke rates. Our findings highlight the need for targeted interventions to improve these disparities in outcomes.

P760Clinical profile of African-American and non-Hispanic caucasian patients with Takotsubo cardiomyopathy syndrome in a large urban hospital in the United States of America

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Westman ◽  
K Ravindra ◽  
J Chiabrando ◽  
D Kadariya ◽  
G Maehara ◽  
...  
Keyword(s):  
United States ◽  
African American ◽  
Hospital Mortality ◽  
United States Of America ◽  
Troponin I ◽  
The United States ◽  
Stress Cardiomyopathy ◽  
Urban Hospital ◽  
Significant Difference ◽  
Caucasian Patients

Abstract Background Takotsubo (stress) cardiomyopathy is an acute reversible heart failure syndrome initially described in Japanese patients, but now well characterized in Caucasians patients in Europe or of European descent. An initial observation has suggested a lower incidence of Takotsubo in non-Caucasian subjects, particularly in the African-American (AA) population in the United States of America. The purpose of this study was to assess whether epidemiologic and clinical differences were present in Takotsubo in a large urban hospital in Virginia, USA. Methods We used an informatics-based system to query electronic health records (TriNetX, Cambridge, MA, USA) to search for cases of Takotsubo between 2010 and 2018 and a corresponding cohort of patients with non-ST segment elevation acute myocardial infarction (NSTEMI). We then performed a chart-level review of 160 cases and obtained additional clinical information including symptoms, risk factors, co-morbidities, and in-hospital outcomes. This retrospective study was approved by the Institutional Review Board of our institution. Results We identified 260 cases of Takotsubo and 6,270 of NSTEMI in the same time period (1:24, 4.2%). Being AA was associated with an odds ratio of Takotsubo versus NSTEMI of 0.38 [0.29–0.50] (P=0.0001). With further evaluation of patients with Takotsubo (N=160), AA (N=44, 27.2%) and Non-Hispanic Caucasian (C) (N=110, 67.9%) had no differences in age and sex. AA patients with Takotsubo however were more likely than C patients to be affected by type II diabetes mellitus (38.6% versus 14.5%, P=0.002, OR 3.70 [1.65–8.28]), have history of drug abuse (27.3% versus 9.1%, P=0.009, OR 3.75 [1.48–9.49]) and of cocaine use in particular (9.1% versus 0.9%, P=0.024, OR 11.0 [1.19–101.4]). The pattern of wall motion abnormality was not different between the 2 groups. AA patients presented with a lower ratio of brain natriuretic peptide (BNP) to troponin I (41.9 [12.7–258] pg./ml versus 281 [42–890] pg/ml, P=0.022). There was no significant difference of in-hospital mortality between the AA and C groups (9.1% versus 25%, respectively, OR 0.40 [0.13–1.24], P=0.11). Conclusions The incidence and clinical characteristics of Takotsubo (stress) cardiomyopathy appear to be different between African-American and Non-Hispanic Caucasian patients. African-American patients are more likely to have diabetes and illicit drug usage, but have a lower BNP/troponin I ratio. Both AA and Non-Hispanic Caucasian patients have similar in-hospital mortality.

Abstract 14703: Sex Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dhiran Verghese ◽  
Sri Harsha Patlolla ◽  
Saraschandra Vallabhajosyula
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
The United States ◽  
Circulatory Support ◽  
Multivariable Logistic Regression Analysis ◽  
Shockable Rhythm ◽  
Sex Disparities

Background: Sex disparities exist in acute cardiovascular care. Despite sex-specific cardiac arrest (CA) research being identified as a priority by professional societies, there are limited studies on this topic. Objectives: To assess sex disparities in management and outcomes of CA complicating acute myocardial infarction (AMI) in a contemporary United States population. Methods: Adult admissions with a primary diagnosis of AMI and concomitant diagnosis of CA were identified using the National Inpatient Sample. Outcomes of interest included sex disparities in in-hospital mortality, coronary angiography (CAG), percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS) use. Results: Between January 1, 2000 and December 31, 2017, 11,622,528 admissions for AMI were identified, of which 584,216 (5.0%) were complicated by CA. Men had higher prevalence of CA compared to women (5.4% vs 4.4%, p< 0.001) in both STEMI and NSTEMI (2017 vs 2000, STEMI-men: 12.3% vs 7.8%, STEMI-women: 10.4% vs 7.5%, NSTEMI-men: 3.1% vs 2.7%, NSTEMI-women: 2.4% vs 2.5%). Women with AMI-CA were on average older (70.4 vs 65.0, p<0.001), of black race (12.6% vs 7.9%, p<0.001) and had higher comorbidity. Women were more likely to present with NSTEMI (36.4% vs 32.3%, p<0.001) and a non-shockable rhythm (47.6% vs 33.3%, p<0.001). Women less frequently received CAG (56.0% vs 66.2 %), early CAG (32.0% vs 40.2%), PCI (40.4% vs 49.7%), MCS (17.6% vs 22.0%), and CABG (all p<0.001). Women had significantly higher unadjusted in-hospital mortality (52.6% vs 40.6%, p < 0.001). In a multivariable logistic regression analysis, female sex was associated with higher in-hospital mortality (OR 1.13 [95% CI 1.11-1.14]; p< 0.001). When stratified by type of rhythm, type of AMI, presence of cardiogenic shock and location of CA, women consistently received less frequent CAG and experienced higher in-hospital mortality. Conclusion: In the largest 18-year study evaluating management and outcomes of CA in AMI, we identified the presence of significant sex disparities. Women with AMI-CA were older, with higher rates of non-shockable rhythm, were less likely to undergo therapeutic procedures including CAG, PCI, and MCS. Women had higher unadjusted and adjusted in-hospital mortality.

P1954Prognostic value of the CHADS2 score for adverse cardiovascular events in acute myocardial infarction patients without atrial fibrillation: J-MINUET Substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Motozato ◽  
K Sakamoto ◽  
K Tsujita ◽  
K Nakao ◽  
Y Ozaki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiovascular Events ◽  
Chads2 Score ◽  
Intermediate Point ◽  
Significant Difference

Abstract Background The CHADS2score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS2 score in predicting cardiovascular events in Japanese acute myocardial infarction (AMI) patients without atrial fibrillation. Methods To elucidate the prognostic value of CHADS2score in AMI patients, we analysed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3,283 AMI patients, who were hospitalized within 48-hours of onset from July 2012 to March 2014. We calculated the CHADS2 scores for 3,044 patients without clinical evidence of atrial fibrillation. The presence of heart failure was substituted by Killip classification>2 on admission. Clinical follow-up data was obtained for 3 years. In addition to the in-hospital mortality,we evaluated cardiovascular events, defined as all cause deathor non-fatal MI during 3-year follow up periods. Results In this study, enrolled patients were classified into low- (point 0–1), intermediate- (point 2–3), and high-score (point 4–6) groups by calculating CHADS2 score. Overall patients with low, intermediate and high score were divided into 1,395, 1,393 and 256 patients, respectively. In-hospital mortality among low, intermediate, and high score groups were 2.8%, 7.4% and 14.8%, respectively (P<0.001). The incidence of cardiovascular eventsamong low, intermediate, and high score groups were 7.8%, 16.3%, 29.3%, respectively (P<0.001). Kaplan-Meier analysis showed a significant difference between the groups (Figure). The event rates were significantly higher in both high score and intermediate score group than in low score group (P<0.001). Multivariate Cox hazard analysis identified CHADS2 score (per 1 point) as an independent predictor of cardiovascular events in addition to chronic kidney disease and lower body mass index. (hazard ratio, 1.344; 95% CI, 1.239–1.459; P<0.001). Among the factors constituting CHADS2 score, heart failure and age were identified as independent predictors for in-hospital mortality. With respect to the cardiovascular event during 3 years, heart failure, age, and previous stroke were revealed as significant independent predictors. Conclusion This large cohort study indicated that the CHADS2 score is useful for the prediction of in-hospital mortality and the cardiovascular events during 3-year follow up in Japanese AMI patients without atrial fibrillation.

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