Female gender is an independent predictor of in-hospital mortality after STEMI in the era of primary PCI: insights from the greater Paris area PCI Registry

Abstract Background: The aim of this study was to determine in-hospital mortality in patients presenting with acute respiratory syndrome corona virus 2 (SARS-CoV-2) and to evaluate for any differences in outcome according to gender. Methods: Patients with SRS-CoV-2 infection were recruited into this retrospective cohort study between February 26 and September 8, 2020 and strаtified ассоrding tо the gender. Results: In tоtаl оf 3360 раtients (meаn аge 44 ± 17 years) were included, of whom 2221 (66%) were mаle. The average length of hospitalization was 13 days (range: 2–31 days). During hospitalization and follow-up 176 patients (5.24%) died. Mortality rates were significantly different according to gender (p=<0.001). Specifically, male gender was associated with significantly greater mortality when compared to female gender with results significant at an alpha of 0.05, LL = 28.67, df = 1, p = 0.001, suggesting that gender could reliably determine mortality rates. The coefficient for the males was significant, B = 1.02, SE = 0.21, HR = 2.78, p< .001, indicating that an observation in the male category will have a hazard 2.78 times greater than that in the female category. Multivariate logistic regression confirmed male patients admitted with SARS-CoV-2had higher сumulаtive аll-саuse in-hоsрitаl mоrtаlity (6.8% vs. 2.3%; аdjusted оdds rаtiо (аОR), 2.80; 95% (СI): [1.61 - 5.03]; р < 0.001). Conclusions: Male gender was an independent predictor of in-hospital death in this study. The mortality rate among male SARS-CoV-2 patients was 2.8 times higher when compared with females.

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FEMALE GENDER IS AN INDEPENDENT PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS HOSPITALIZED WITH DIZZINESS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60082-0 ◽

2013 ◽

Vol 61 (10) ◽

pp. E81

Author(s):

Amar Salam ◽

Hajar Albinali ◽

Rajvir Singh ◽

Nidal Asaad ◽

Awad Alqahtani ◽

...

Keyword(s):

Hospital Mortality ◽

Independent Predictor ◽

Female Gender

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Female gender is an independent predictor of superior perioperative survival following non-small cell lung cancer (NSCLC) resection

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7150 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7150-7150

Author(s):

B. J. Park ◽

N. Rizk ◽

R. M. Flores ◽

R. Downey ◽

M. S. Bains ◽

...

Keyword(s):

Lung Cancer ◽

Hospital Mortality ◽

Surgical Resection ◽

Induction Therapy ◽

Independent Predictor ◽

Lung Resection ◽

Female Gender ◽

Extent Of Resection ◽

Diffusion Capacity ◽

Co Morbidity

7150 Background: Selecting patients who will benefit from surgical resection of NSCLC, especially following induction therapy, can be challenging. We analyzed our modern experience to determine factors associated with superior operative outcomes. Methods: A retrospective review of a prospectively maintained database of consecutive NSCLC patients who underwent surgical exploration for resection from January 1999 through June 2005 was performed. Factors evaluated included age, sex, co-morbidities, use of induction therapy, previous thoracic operations, extent of lung resection, and in-hospital mortality. Associations between categorical variables were evaluated with a chi-squared test and for continuous variables with an analysis of variance. Multivariate analysis was done with a logistic regression model. Results: A total of 2,524 patients underwent attempt at surgical resection, 1,398 of whom were female (55.4%). One hundred and four (4.1%) patients had exploration only. The majority of patients underwent lobectomy (1,692/2,524, 67.1%), and 6.1% (154/2,524) had a pneumonectomy. Induction therapy was given in 492 patients (19.5%). Univariate analysis showed that male gender (2.4% vs 0.93%, respectively, p = 0.003), presence of cardiac co-morbidity (p = 0.05), poor diffusion capacity (p = 0.003), and greater extent of resection (p = 0.01) were associated with increased in-hospital mortality. Multivariate analysis controlling for gender, age, diffusion capacity, cardiac, and diabetic co-morbidity, as well as prior lung cancer operation, extent of resection and use of induction therapy demonstrated that increased age, decreased diffusion capacity and greater anatomic lung resection were risk factors for higher in-hospital mortality. However, female sex was an independent predictor of lower in-hospital mortality (OR 0.41, p = 0.01). Conclusions: In addition to other previously described predictors of poor surgical outcome, such as advanced age, poor lung function and greater extent of lung removal, we observed that female gender appears to be associated with better in-hospital survival following surgical resection of NSCLC. No significant financial relationships to disclose.

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Gender in non- ST elevation myocardial infarction and unstable angina: is there any equality?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1760 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Lopes ◽

C Saleiro ◽

D Campos ◽

J Sousa ◽

L Puga ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Unstable Angina ◽

Independent Predictor ◽

Female Gender ◽

St Elevation Myocardial Infarction ◽

Angiotensin Ii Receptor Blocker ◽

Gender Specific Differences ◽

St Elevation ◽

Gender Specific

Abstract Background Historically, women (W) with acute coronary syndrome (ACS) have worse outcomes compared with men (M). This fact may occur due to gender-specific differences in the presentation and management of patients (P), which were mainly observed in studies dealing with ST-segment elevation infarction (STEMI). There seems to be a gap of knowledge in gender-specific differences in non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Purpose Assess gender-specific differences in presentation, treatment and outcomes in NSTEMI and UA patients. Methods A retrospective cohort study from consecutive ACS patients enrolled in a multicentre national registry from October 2010 to December 2018 was conducted, identifying 11394 P admitted with NSTEMI or UA. Demographic, clinical and treatment variables were compared between male gender and female gender P. A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints: mortality at 1-year (1y) and cardiovascular (CV) hospitalization at 1-year. Results A total 11394 P were included, 8145 M (71.5%) and 3249 W (28.5%), mean age of 68±13. W, comparing with M, had higher age (72±12 vs 66±13, p=0.001), higher prevalence of hypertension (85% vs 72%, p=0.001) and diabetes (41% vs 34%, p=0.001) and longer time from symptoms to hospital admission (360 minutes vs 297 minutes, p=0.001). Chest pain was less frequent as first symptom in W (85.6% vs 91.3%, p=0.001). In medical treatment, W had higher chance of not having administration of a loading dose of P2Y12 inhibitor (22.1% vs 18.1, p=0.001) and of being medicated with clopidogrel (85.7% vs 82.1%, p=0.002). At discharge, W were less frequently medicated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (82.6% vs 84.4, p=0.028). Coronary angiography was less frequently performed in W (77.3% vs 85.7%, p=0.001). Coronary artery disease was less frequently found in the female gender (12.4% vs 4.8%, p=0.001). In-hospital mortality was higher in W (2.9% vs 2.1%), but in the multivariate analysis the female gender was not an independent predictor of in-hospital mortality (OR 1.05 [0.67- 1.65], p=0.823). 1-year mortality was higher in W (9.2% vs 7.3%) and 1-year CV hospitalization was higher in M (16.8% vs 14.4%). After adjusting for covariates in Cox regression analysis, difference was still significant for mortality (HR= 1.274 [1.038 - 1.564], p=0.02) and hospitalization (HR = 0.852 [0.726- 0.998], p=0.047). Conclusion In this NSTEMI and UA cohort, there are important gender-specific differences in comorbidities, diagnosis, management and outcomes. Gender was an independent predictor of 1-year mortality and 1-year CV hospitalization, but not an independent predictor for in-hospital mortality. Funding Acknowledgement Type of funding source: None

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Renin-angiotensin-aldosterone system blockers could contribute to the gender-related disparities in STEMI outcomes

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.066 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

A Scridon ◽

L Hadadi ◽

I Sus ◽

EK Lakatos ◽

Z Demjen ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Length Of Hospital Stay ◽

Female Gender ◽

Primary Pci ◽

Kidney Dysfunction ◽

Female Patients ◽

Diuretic Drugs ◽

Male Patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS - UEFISCDI BACKGROUND Women with ST-segment elevation myocardial infarction (STEMI) have been shown to present higher in-hospital mortality compared to their male counterparts. However, most of these data were obtained in the pre-percutaneous coronary intervention (PCI) or even in the pre-thrombolytic era. PURPOSE We aimed to investigate the contribution of female gender to the occurrence of in-hospital complications in STEMI patients treated by primary PCI. METHODS Data regarding in-hospital outcomes (i.e., mortality, inotropic and diuretic drugs usage, occurrence of cardiogenic shock, cardiac arrest) were evaluated in 848 consecutive patients treated by primary PCI for STEMI. Occurrence of new-onset kidney dysfunction and length of hospital stay were also analysed. The relationship between gender and the occurrence of STEMI-related complications was evaluated. RESULTS Out of the 848 patients included in the study, 254 (29.9%) were women. Compared to their male counterparts, female STEMI patients were older (65.7 ± 11.3 vs. 60.1 ± 11.8 years; p< 0.0001), had more often pre-existing heart failure, hypertension, diabetes mellitus, and chronic kidney disease (all p< 0.05), longer symptom onset-to-cardiac catheterization laboratory time intervals (7.9 ± 6.7 vs. 6.4 ± 5.0 h; p< 0.001), and higher Killip class on admission (p = 0.02). Cardiogenic shock, inotropic and diuretic drugs usage, kidney dysfunction, and cardiac arrest occurred more often in female than in male patients (all p< 0.01). The length of hospital stay (p< 0.01) and in-hospital death (RR 1.89 [95%CI 1.43-2.50], p< 0.001) were also higher in female compared to male patients, whereas renin-angiotensin-aldosterone system (RAAS) blockers were used more rarely in female patients (p = 0.01). When corrected for potential confounders, female gender remained an independent predictor of in-hospital mortality (p = 0.01). However, when in-hospital RAAS blockers usage was included in the model, female gender was no longer associated with increased in-hospital mortality (p = 0.15). CONCLUSIONS Female patients with STEMI continue to display significantly higher in-hospital mortality rates compared to their male peers including in the primary PCI era. The difference in in-hospital mortality between female and male patients with STEMI could be at least partially due to the significantly lower usage of RAAS blockers in women. Increasing in-hospital RAAS blockers usage in female patients with STEMI may improve survival in this high-risk population.

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Evaluation of clinical features and metrics of care in women with st-elevation myocardial infarction treated in a pharmaco-invasive strategy network

European Heart Journal ◽

10.1093/ehjci/ehaa946.1626 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E.S Melo ◽

P.M Veloso ◽

A.S Terencio ◽

J.G Souza ◽

E.P Batista ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Regression Model ◽

Cardiac Catheterization ◽

Independent Predictor ◽

Female Gender ◽

Risk Profile ◽

St Elevation Myocardial Infarction ◽

Invasive Strategy ◽

St Elevation

Abstract Introduction Despite worse cardiovascular outcomes, including higher mortality, reported in women with acute myocardial infarction, it is uncertain whether these differences can be explained by a discordant risk profile between genders. Objective To compare clinical data and metrics of care between women and men diagnosed with ST elevation myocardial infarction (STEMI). Methods We analyzed 2723 consecutive STEMI patients, of whom 29.8% (811) were women, treated in a regional network from March-2010 to December-2019, first seen in primary hospitals, where they received fibrinolysis (96% tenecteplase), and then systematically transferred to a tertiary center for cardiac catheterization (pharmaco-invasive strategy). Categorical variables were compared using chi-square test and numerical variables expressed as median and interquartile range and compared using Mann-Whitney test. A binary logistic regression model was developed to determine whether female gender was an independent predictor of mortality. Results Compared to men, women were older (60 [53–69] x 56 [49–63] years; p<0.01), had more hypertension (68.9% x 56.5%; p<0.01), diabetes (36.6% x 28.3%; p<0.01), hypothyroidism (12.0% x 3.3%; p<0.01), kidney failure with an estimated creatinine clearance <60 mL/min (24.7% x 15.4%; p<0.01) and higher baseline LDL-cholesterol (128 [107–160] x 124 [100–154] mg / dL; p=0.03). Smoking (65.2% x 58.2%; p<0.01) and alcoholism (16.1% x 3.1%; p<0.01) were more frequent in men. Regarding the metrics of care, women had longer times from symptoms onset to first medical contact (120 [60–240] x 115 [60–210] minutes; p=0.02) and longer pain-to-needle median times (69 [42–120] x 72 [49–120] minutes; p=0.03). There was no difference between genders regarding percentage of failure reperfusion after lytic, median time from fibrinolysis to cardiac catheterization, maximum troponin values and days of hospitalization. Women had higher unadjusted in-hospital mortality (8.0% x 4.8%; p<0.01). However, after adjusting for confounding variables in the multivariate regression model, the female gender was not an independent predictor of death (odds ratio 1.17 with a 95% confidence interval of 0.69–1.80). Conclusion After adjusting for risk variables, female gender was not related to higher in-hospital mortality in STEMI patients treated with pharmaco-invasive strategy. However, women had a higher cardiovascular risk profile compared to men and worse metrics of care, including greater delay in reperfusion therapy. Funding Acknowledgement Type of funding source: None

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Incidence, predictors and prognostic implications of bleeding complicating primary percutaneous coronary intervention

Vojnosanitetski pregled ◽

10.2298/vsp140223064m ◽

2015 ◽

Vol 72 (7) ◽

pp. 589-595 ◽

Cited By ~ 9

Author(s):

Dragan Matic ◽

Milika Asanin ◽

Sanja Stankovic ◽

Igor Mrdovic ◽

Jelena Marinkovic ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Major Bleeding ◽

Primary Percutaneous Coronary Intervention ◽

Independent Predictor ◽

Female Gender ◽

Coronary Intervention ◽

Primary Pci ◽

Killip Class ◽

Percutaneous Coronary ◽

Wbc Count

Background/Aim. Data about bleeding complicating primary percutaneous coronary intervention (PCI) are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS), but less frequently from surveys or registries on patients with STelevation myocardial infarction (STEMI). The aim of this study was to investigate the incidence, predictors and prognostic impact of in-hospital major bleeding in the population of unselected real-world patients with acute STEMI undergoing primary PCI. Methods. All consecutive patients presenting with STEMI who underwent primary PCI at a single large tertiary healthcare center between January 2005 and July 2009, were studied. Major bleeding was defined according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) study criteria. We examined the association between in-hospital major bleeding and death or major adverse cardiac events (MACE) in patients treated with PCI. The primary outcomes were in-hospital and 6-month mortality and MACE. Results. Of the 770 STEMI patients treated with primary PCI, in-hospital major bleeding occurred in 32 (4.2%) patients. Independent predictors of major bleeding were advanced age (? 65 years), female gender, baseline anemia and elevated white blood cell (WBC) count and signs of congestive heart failure at admission (Killip class II-IV). In-hospital and 6-month mortality and MACE rates were more than 2.5-fold-higher in patients who developed major bleeding compared with those who did not. Major bleeding was a predictor of 6- month MACE, independent of a few risk factors (previous MI, previous PCI, diabetes mellitus and hypertension); (OR = 3.02; 95% CI for OR 1.20-7.61; p = 0.019), but was not a true independent predictor of MACE and mortality in the fully adjusted models. Conclusion: Patients of advanced age, female gender, with baseline anemia and elevated WBC count and those with Killip class II-IV at presentation are at particularly high risk of bleeding after primary PCI. Bleeding is associated with adverse outcome and may be an important marker of patient frailty, but it is not a true independent predictor of mortality/MACE.

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The short-term prognostic value of serum platelet to hemoglobin in patients with type A acute aortic dissection

Perfusion ◽

10.1177/0267659120982226 ◽

2020 ◽

pp. 026765912098222

Author(s):

Yu Wang ◽

Tengfei Qiao ◽

Jun Zhou

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Acute Aortic Dissection ◽

Independent Predictor ◽

Type A ◽

Short Term ◽

Survivor Group ◽

Mortality Hazard ◽

Mortality Hazard Ratio ◽

The Ideal

Purpose: Type A acute aortic dissection (AAD) is an uncommon catastrophic cardiovascular disease with high pre-hospital mortality rate without timely and effectively treated. The aim of this study was to assess the value of serum platelet to hemoglobin (PHR) in predicting in-hospital mortality in type A AAD patients. Methods: A total of 183 type A AAD patients were included in this retrospective investigation from January 2017 to December 2019. Admission blood routine parameters were gathered and PHR was computed. The outcome was all-cause in-hospital mortality within 30 days. Results The average levels of serum PHR were significant higher in survivor group than those in non-survivor group (1.14 ± 0.57 vs 0.87 ± 0.47, p = 0.006) and serum PHR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 2.831; 95% confidence interval (CI): 1.108–7.231; p = 0.030). ROC noted that 0.8723 was chosen as the ideal cutoff value with a sensitivity of 64.3% and specificity of 72.5%. In addition, the area under the ROC curve (AUC) was 0.693 (95% CI 0.599–0.787, p < 0.001). Conclusion: Admission serum PHR can be used as an independent predictor of in-hospital mortality in patients with type A AAD.

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Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

European Heart Journal ◽

10.1093/ehjci/ehaa946.1615 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Fernandes ◽

F Montenegro ◽

M Cabral ◽

R Carvalho ◽

L Santos ◽

...

Keyword(s):

Hospital Mortality ◽

Right Bundle Branch Block ◽

Independent Predictor ◽

Left Ventricular Ejection ◽

Bundle Branch Block ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Intraventricular Conduction ◽

St Segment ◽

Worse Prognosis

Abstract Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage. Purpose To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location. Methods From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography. Results 7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class>1 (OR 2.26, 95% CI 1.45–3.53, p<0.001), left ventricular ejection fraction <50% (OR 3.93, 95% CI 2.19–7.05, p<0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009). Conclusion In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality. Funding Acknowledgement Type of funding source: None

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