Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Follow-Up and Survival Analysis
3.3. Cholesterol Profile Management
4. Discussion
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Ibanez, B.; James, S.; Agewall, S.; Antunes, M.J.; Bucciarelli-Ducci, C.; Bueno, H.; Caforio, A.L.P.; Crea, F.; Goudevenos, J.A.; Halvorsen, S.; et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018, 39, 119–177. [Google Scholar]
- Gale, C.P.; Allan, V.; Cattle, B.A.; Hall, A.S.; West, R.M.; Timmis, A.; Gray, H.H.; Deanfield, J.; Fox, K.A.A.; Feltbower, R. Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: A multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR). Heart Br. Card. Soc. 2014, 100, 582–589. [Google Scholar] [CrossRef] [PubMed]
- Ibánez, B.; James, S.; Agewall, S.; Antunes, M.J.; Bucciarelli-Ducci, C.; Bueno, H.; Caforio, A.L.P.; Crea, F.; Goudevenos, J.A.; Halvorsen, S.; et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev. Esp. Cardiol. Engl. Ed. 2017, 70, 1082. [Google Scholar] [CrossRef]
- Fernández de Larrea-Baz, N.; Morant-Ginestar, C.; Catalá-López, F.; Gènova-Maleras, R.; Álvarez-Martín, E. Disability-adjusted Life Years Lost to Ischemic Heart Disease in Spain. Rev. Esp. Cardiol. Engl. Ed. 2015, 68, 968–975. [Google Scholar] [CrossRef]
- Schnohr, P.; Jensen, J.S.; Scharling, H.; Nordestgaard, B.G. Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12,000 men and women from The Copenhagen City Heart Study. Eur. Heart J. 2002, 23, 620–626. [Google Scholar] [CrossRef] [PubMed]
- Ruiz Pizarro, V.; Palacios-Rubio, J.; Cruz-Utrilla, A.; García-Arribas, D.; Pérez-Vizcayno, M.J.; Fernández-Ortiz, A.; Núñez-Gil, I.J. ST-Elevation Myocardial Infarction in Patients ≤35 Years of Age. Am. J. Cardiol. 2019, 123, 889–893. [Google Scholar] [CrossRef]
- Davia, J.E.; Hallal, F.J.; Cheitlin, M.D.; Gregoratos, G.; McCarty, R.; Foote, W. Coronary artery disease in young patients: Arteriographic and clinical review of 40 cases aged 35 and under. Am. Heart J. 1974, 87, 689–696. [Google Scholar] [CrossRef]
- Fournier, J.A.; Sánchez, A.; Quero, J.; Fernández-Cortacero, J.A.; González-Barrero, A. Myocardial infarction in men aged 40 years or less: A prospective clinical-angiographic study. Clin. Cardiol. 1996, 19, 631–636. [Google Scholar] [CrossRef]
- Shehab, A.; AlHabib, K.F.; Bhagavathula, A.S.; Hersi, A.; Alfaleh, H.; Alshamiri, M.Q.; Ullah, A.; Sulaiman, K.; Almahmeed, W.; Al Suwaidi, J.; et al. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries. Curr. Vasc. Pharmacol. 2019, 17, 388–395. [Google Scholar] [CrossRef] [PubMed]
- D’Onofrio, G.; Safdar, B.; Lichtman, J.H.; Strait, K.M.; Dreyer, R.P.; Geda, M.; Spertus, J.A.; Krumholz, H.M. Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: Results from the VIRGO study. Circulation 2015, 131, 1324–1332. [Google Scholar] [CrossRef]
- Khera, S.; Kolte, D.; Gupta, T.; Subramanian, K.S.; Khanna, N.; Aronow, W.S.; Ahn, C.; Timmermans, R.J.; Cooper, H.A.; Fonarow, G.C.; et al. Temporal Trends and Sex Differences in Revascularization and Outcomes of ST-Segment Elevation Myocardial Infarction in Younger Adults in the United States. J. Am. Coll. Cardiol. 2015, 66, 1961–1972. [Google Scholar] [CrossRef]
- Manzo-Silberman, S.; Couturaud, F.; Charpentier, S.; Auffret, V.; El Khoury, C.; Le Breton, H.; Belle, L.; Marlière, S.; Zeller, M.; Cottin, Y.; et al. Influence of gender on delays and early mortality in ST-segment elevation myocardial infarction: Insight from the first French Metaregistry, 2005–2012 patient-level pooled analysis. Int. J. Cardiol. 2018, 262, 1–8. [Google Scholar] [CrossRef]
- Piackova, E.; Jäger, B.; Farhan, S.; Christ, G.; Schreiber, W.; Weidinger, F.; Stefenelli, T.; Delle-Karth, G.; Kaff, A.; Maurer, G.; et al. Gender differences in short- and long-term mortality in the Vienna STEMI registry. Int. J. Cardiol. 2017, 244, 303–308. [Google Scholar] [CrossRef]
- Gupta, A.; Barrabes, J.A.; Strait, K.; Bueno, H.; Porta-Sánchez, A.; Acosta-Vélez, J.G.; Lidón, R.-M.; Spatz, E.; Geda, M.; Dreyer, R.P.; et al. Sex Differences in Timeliness of Reperfusion in Young Patients With ST-Segment-Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics. J. Am. Heart Assoc. 2018, 7, e007021. [Google Scholar] [CrossRef] [PubMed]
- Pagidipati, N.J.; Peterson, E.D. Acute coronary syndromes in women and men. Nat. Rev. Cardiol. 2016, 13, 471–480. [Google Scholar] [CrossRef] [PubMed]
- Thygesen, K.; Alpert, J.S.; Jaffe, A.S.; Chaitman, B.R.; Bax, J.J.; Morrow, D.A.; White, H.D.; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). Circulation 2018, 138, e618–e651. [Google Scholar] [CrossRef] [PubMed]
- Collet, J.-P.; Thiele, H.; Barbato, E.; Barthélémy, O.; Bauersachs, J.; Bhatt, D.L.; Dendale, P.; Dorobantu, M.; Edvardsen, T.; Folliguet, T.; et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 2020. [Google Scholar] [CrossRef]
- Programme, W.H.G. Familial Hypercholesterolaemia (FH): Report of a Second WHO Consultation, Geneva, 4 September 1998. 1999. Available online: https://apps.who.int/iris/handle/10665/66346 (accessed on 17 March 2021).
- Cannon, R.O. Chest pain with normal coronary angiograms. N. Engl. J. Med. 1993, 328, 1706–1708. [Google Scholar] [CrossRef] [PubMed]
- Garcia-Garcia, H.M.; McFadden, E.P.; Farb, A.; Mehran, R.; Stone, G.W.; Spertus, J.; Onuma, Y.; Morel, M.-A.; van Es, G.-A.; Zuckerman, B.; et al. Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Circulation 2018, 137, 2635–2650. [Google Scholar] [CrossRef]
- Pascual, I.; Avanzas, P.; Almendárez, M.; Lorca, R.; Vigil-Escalera, M.; Arboine, L.; Alperi, A.; Adeba, A.; Díaz, R.; Silva, J.; et al. STEMI, primary percutaneous coronary intervention and recovering of life expectancy: Insights from the SurviSTEMI study. Rev. Esp. Cardiol. Engl. Ed. 2020. [Google Scholar] [CrossRef]
- Pascual, I.; Hernandez-Vaquero, D.; Almendarez, M.; Lorca, R.; Escalera, A.; Díaz, R.; Alperi, A.; Carnero, M.; Silva, J.; Morís, C.; et al. Observed and Expected Survival in Men and Women after Suffering a STEMI. J. Clin. Med. 2020, 9, 1174. [Google Scholar] [CrossRef]
- Bandyopadhyay, D.; Chakraborty, S.; Amgai, B.; Patel, N.; Hajra, A.; Heise, L.; Sud, K.; Ghosh, R.K.; Herzog, E.; Aronow, W.S.; et al. Acute myocardial infarction in the young—National Trend Analysis with gender-based difference in outcomes. Int. J. Cardiol. 2020, 301, 21–28. [Google Scholar] [CrossRef] [PubMed]
- Shehab, A.; Bhagavathula, A.S.; Alhabib, K.F.; Ullah, A.; Suwaidi, J.A.; Almahmeed, W.; AlFaleh, H.; Zubaid, M. Age-Related Sex Differences in Clinical Presentation, Management, and Outcomes in ST-Segment-Elevation Myocardial Infarction: Pooled Analysis of 15,532 Patients from 7 Arabian Gulf Registries. J. Am. Heart Assoc. 2020, 9, e013880. [Google Scholar] [CrossRef] [PubMed]
- Liu, J.; Elbadawi, A.; Elgendy, I.Y.; Megaly, M.; Ogunbayo, G.O.; Krittanawong, C.; Tamis-Holland, J.E.; Ballantyne, C.M.; Khalid, M.U.; Virani, S.; et al. Age-Stratified Sex Disparities in Care and Outcomes in Patients with ST-Elevation Myocardial Infarction. Am. J. Med. 2020, 133, 1293–1301.e1. [Google Scholar] [CrossRef] [PubMed]
- Champney, K.P.; Frederick, P.D.; Bueno, H.; Parashar, S.; Foody, J.; Merz, C.N.B.; Canto, J.G.; Lichtman, J.H.; Vaccarino, V.; NRMI Investigators. The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart Br. Card. Soc. 2009, 95, 895–899. [Google Scholar] [CrossRef] [PubMed]
- Valero-Masa, M.J.; Velásquez-Rodríguez, J.; Diez-Delhoyo, F.; Devesa, C.; Juárez, M.; Sousa-Casasnovas, I.; Angulo-Llanos, R.; Fernández-Avilés, F.; Martínez-Sellés, M. Sex differences in acute myocardial infarction: Is it only the age? Int. J. Cardiol. 2017, 231, 36–41. [Google Scholar] [CrossRef] [PubMed]
- Barthélémy, O.; Degrell, P.; Berman, E.; Kerneis, M.; Petroni, T.; Silvain, J.; Payot, L.; Choussat, R.; Collet, J.-P.; Helft, G.; et al. Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Arch. Cardiovasc. Dis. 2015, 108, 428–436. [Google Scholar] [CrossRef]
- Gupta, A.; Wang, Y.; Spertus, J.A.; Geda, M.; Lorenze, N.; Nkonde-Price, C.; D’Onofrio, G.; Lichtman, J.H.; Krumholz, H.M. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J. Am. Coll. Cardiol. 2014, 64, 337–345. [Google Scholar] [CrossRef]
- Chandrasekhar, J.; Gill, A.; Mehran, R. Acute myocardial infarction in young women: Current perspectives. Int. J. Womens Health 2018, 10, 267–284. [Google Scholar] [CrossRef]
- Dreyer, R.P.; Dharmarajan, K.; Kennedy, K.F.; Jones, P.G.; Vaccarino, V.; Murugiah, K.; Nuti, S.V.; Smolderen, K.G.; Buchanan, D.M.; Spertus, J.A.; et al. Sex Differences in 1-Year All-Cause Rehospitalization in Patients After Acute Myocardial Infarction: A Prospective Observational Study. Circulation 2017, 135, 521–531. [Google Scholar] [CrossRef]
- García-García, C.; Molina, L.; Subirana, I.; Sala, J.; Bruguera, J.; Arós, F.; Fiol, M.; Serra, J.; Marrugat, J.; Elosua, R. Sex-based differences in clinical features, management, and 28-day and 7-year prognosis of first acute myocardial infarction. RESCATE II study. Rev. Esp. Cardiol. Engl. Ed. 2014, 67, 28–35. [Google Scholar] [CrossRef] [PubMed]
- Kardys, I.; Vliegenthart, R.; Oudkerk, M.; Hofman, A.; Witteman, J.C.M. The female advantage in cardiovascular disease: Do vascular beds contribute equally? Am. J. Epidemiol. 2007, 166, 403–412. [Google Scholar] [CrossRef] [PubMed]
- Nicholls, S.J.; Wolski, K.; Sipahi, I.; Schoenhagen, P.; Crowe, T.; Kapadia, S.R.; Hazen, S.L.; Tuzcu, E.M.; Nissen, S.E. Rate of progression of coronary atherosclerotic plaque in women. J. Am. Coll. Cardiol. 2007, 49, 1546–1551. [Google Scholar] [CrossRef]
- Lawesson, S.S.; Stenestrand, U.; Lagerqvist, B.; Wallentin, L.; Swahn, E. Gender perspective on risk factors, coronary lesions and long-term outcome in young patients with ST-elevation myocardial infarction. Heart Br. Card. Soc. 2010, 96, 453–459. [Google Scholar] [CrossRef] [PubMed]
- Saw, J.; Humphries, K.; Aymong, E.; Sedlak, T.; Prakash, R.; Starovoytov, A.; Mancini, G.B.J. Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence. J. Am. Coll. Cardiol. 2017, 70, 1148–1158. [Google Scholar] [CrossRef]
- Vautrin, E.; Jean, A.-E.B.P.; Fourny, M.; Marlière, S.; Vanzetto, G.; Bouvaist, H.; Debaty, G.; Belle, L.; Danchin, N.; Labarère, J. Sex differences in coronary artery lesions and in-hospital outcomes for patients with ST-segment elevation myocardial infarction under the age of 45. Catheter. Cardiovasc. Interv. Off. J. Soc. Card. Angiogr. Interv. 2020, 96, 1222–1230. [Google Scholar] [CrossRef]
- Adams, H.; Paratz, E.; Somaratne, J.; Layland, J.; Burns, A.; Palmer, S.; MacIsaac, A.; Whitbourn, R. Different patients, different outcomes: A case-control study of spontaneous coronary artery dissection versus acute coronary syndrome. J. Interv. Cardiol. 2018, 31, 41–47. [Google Scholar] [CrossRef] [PubMed]
Global (366) | Men (303) | Women (63) | p Value | |
---|---|---|---|---|
Age (years) | Mean 48.85 (±5.5 SD) | 48.3(5.1) | 51.6 (6.3) | <0.001 |
Referred due to cardiac arrest | 13 (3.5%) | 10 (3.3%) | 3 (4.8%) | 0.57 |
BMI | Mean 28.3 (±4.5 SD) | 28.45 (4.3) | 27.4 (5.2) | 0.13 |
Chronic KIDNEY DISEASE * | 2 (0.55%) | 2 (0.7%) | 0 | 0.51 |
Family history of premature cardiovascular disease | 106 (29%) | 93 (30.7%) | 13 (20.6%) | 0.11 |
Cardiovascular risk factors prior to STEMI | ||||
Hypertension | 99 (27%) | 80 (26.4%) | 19 (30.2%) | 0.54 |
Diabetes | 35 (9.6%) | 22 (7.3%) | 13 (20.6%) | 0.001 |
Active smokers Ex-smokers | 274 (74.9%) 35 (9.6%) | 229 (75.6%) 31 (10.2%) | 45 (71.4) 4 (6.35%) | 0.08 |
Dyslipidemia | 132 (9.1%) | 113 (37.3%) | 19 (30.2%) | 0.28 |
Previous LDLc | Median 156 (123–176) Mean 150.09 (±43.15 SD) | 156 (122–176) | 156 (126–173) | 0.66 |
Previous myocardial infarction | 29 (7.9%) | 27 (8.9%) | 2 (3.2%) | 0.19 |
At admission | ||||
-New Diabetes diagnosis | 18 (4.9%) | 16 (5.3%) | 2 (3.2%) | 0.83 |
-LDLc levels | 0.95 | |||
Mean 116.76 (±40.1 SD) | 116.70 (39.8) | 117.06 (42.1) | ||
<116 | 177 (48.4%) | 144 (47.5%) | 33 (52.4%) | |
116–155 | 101 (27.6%) | 92 (30.4%) | 9 (14.3%) | |
155–190 | 40 (10.9%) | 31 (10.2%) | 9 (14.3%) | |
≥190 | 11 (3%) | 10 (3.3%) | 1 (1.6%) | |
Unavailable | 37 (10.1%) | 26 (8.6%) | 11 (17.5%) | |
Culprit artery: | 0.47 | |||
-Left Main | 11 (3%) | 11 (3.6%) | 0 | |
-LAD | 143 (39.1%) | 116 (38.3%) | 27 (43.85%) | |
-LCX | 61 (16.7%) | 55 (18.15%) | 6 (9.5%) | |
-RCA | 151 (41.3%) | 121 (39.9%) | 30 (47%) | |
Spontaneous coronary artery dissection | 7 (1.9%) | 0 | 7 (11.1%) | <0.001 |
Multivessel Disease | 119 (34.4%) | 104 (35.7%) | 15 (27.3%) | 0.23 |
Average hospital stay | Mean 5.7 (±10.2 SD) | 5.76 (±10.4 SD) | 5.3 (±9 SD) | 0.19 |
LVEF at discharge | 54.55 (± 9.5 SD) | 54.50 (±9.25 SD) | 54.83 (±10.7 SD) | 0.82 |
Global | Men | Women | p Value | |
---|---|---|---|---|
preSTEMI | ||||
<116 | 40 (10.9%) | 34 (11.2%) | 6 (17.1%) | 0.7979 |
116–154.9 | 56 (15.3%) | 46 (15.2%) | 10 (28.6%) | |
155–189.9 | 81 (22.1%) | 68 (22.4%) | 13 (20.6%) | |
≥190 | 28 (7.7%) | 22 (7.26%) | 6 (9.5%) | |
Unavailable | 161 (43.9%) | 133 (43.9%) | 28 (44.4%) | |
At STEMI | ||||
<116 | 177 (48.4%) | 144 (47.5%) | 33 (52.4%) | 0.7069 |
116–154.9 | 101 (27.6%) | 92 (30.4%) | 9 (14.3%) | |
155–189.9 | 40 (10.9%) | 31 (10.2%) | 9 (14.3%) | |
≥190 | 11 (3%) | 10 (3.3%) | 1 (1.6%) | |
Unavailable | 37 (10.1%) | 26 (8.6%) | 11 (17.5%) | |
postSTEMI | Global (344) | |||
<55 | 82 (23.8%) | 70 (24.1%) | 12 (22.2%) | 0.6912 |
55–70 | 63 (18.3%) | 52 (17.9%) | 11 (20.4%) | |
70–116 | 109 (31.7%) | 89 (30.7%) | 20 (37%) | |
116–190 | 16 (4.65%) | 14 (4.8%) | 2 (3.7%) | |
Unavailable | 74 (21.5%) | 65 (22.4%) | 9 (16.7%) |
Statins at STEMI Discharge | Global (n = 344) | Men (n = 290) | Women (n = 54) | p Value |
---|---|---|---|---|
High-intensity statins | 295 (85.8%) | 246 (84.8%) | 49 (90.8%) | 0.5471 |
Medium-intensity statins | 15 (4.3%) | 13 (4.5%) | 3 (3.7%) | |
Statins + fibrates or ezetimibe | 19 (5.5%) | 18 (6.2%) | 1 (1.9%) | |
Without statins at discharge | 2 (0.6%) | 2 (0.7%) | 0 (0%) | |
Unavailable | 13 (3.8%) | 11 (3.8%) | 2 (3.7%) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lorca, R.; Pascual, I.; Aparicio, A.; Junco-Vicente, A.; Alvarez-Velasco, R.; Barja, N.; Roces, L.; Suárez-Cuervo, A.; Diaz, R.; Moris, C.; et al. Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis. J. Clin. Med. 2021, 10, 1314. https://doi.org/10.3390/jcm10061314
Lorca R, Pascual I, Aparicio A, Junco-Vicente A, Alvarez-Velasco R, Barja N, Roces L, Suárez-Cuervo A, Diaz R, Moris C, et al. Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis. Journal of Clinical Medicine. 2021; 10(6):1314. https://doi.org/10.3390/jcm10061314
Chicago/Turabian StyleLorca, Rebeca, Isaac Pascual, Andrea Aparicio, Alejandro Junco-Vicente, Rut Alvarez-Velasco, Noemi Barja, Luis Roces, Alfonso Suárez-Cuervo, Rocio Diaz, Cesar Moris, and et al. 2021. "Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis" Journal of Clinical Medicine 10, no. 6: 1314. https://doi.org/10.3390/jcm10061314
APA StyleLorca, R., Pascual, I., Aparicio, A., Junco-Vicente, A., Alvarez-Velasco, R., Barja, N., Roces, L., Suárez-Cuervo, A., Diaz, R., Moris, C., Hernandez-Vaquero, D., & Avanzas, P. (2021). Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis. Journal of Clinical Medicine, 10(6), 1314. https://doi.org/10.3390/jcm10061314