Practice Update: Cardiology

CONFERENCE COVERAGE 12

European Society of Cardiology Congress 2017 26–30 AUGUST 2017 • BARCELONA, SPAIN

ESC 2017: The Gender Gap in Death fromAcuteMyocardial Infarction Is Closing, Particularly inWomen Younger Than Age 60 The gender gap in death from acute myocardial infarction has been closing over the past two decades, particularly in women younger than 60 years of age. The retrospective analysis included over 50,000 patients and found that overall in-hospital mortality for patients with acute myocardial infarction halved over the 20-year period. It was presented at the 2017 European Society of Cardiology (ESC) Congress, from August 26–30. D ragana Radovanovic, MD, of the AMIS Plus Data Centre, University of Zurich, Switzerland, explained that research Mean age did not change for either gender during the observation period. confidence interval 0.80–0.94, P < .001) but was not significant in men (odds ratio 0.98, 95% confidence interval 0.94–1.03). The interaction between gender and admission year was significant at P = .006.

The researchers found a decrease in crude in-hospital mortality from 1997 to 2016. In STEMI patients, in-hospital mortality dropped significantly, from 9.8% to 5.5% in men and from 18.3% to 6.9% in women (P < .001 for both). In NSTEMI patients, it fell from 7.1% to 2.1% in men and 11.0% to 3.6% in women (P < .001 for both). Dr. Radovanovic said that in-hospital mor- tality of patients with acute myocardial infarction fell by at least half over the 20-year period. Differences in death rates between men and women also dropped. Previous research showed that younger women with acute myocardial infarction experienced higher mortality than men of similar age; therefore, Dr. Radovanovic and coinvestiga- tors analyzedmortality separately in patients younger than 60 years of age. In women, they found 6% and 13% decreases in mortality with each sub- sequent admission year for STEMI and NSTEMI, respectively. No significant decreases were observed in men younger than 60 years of age. Mortality per year decreased dramatically in NSTEMI women (odds ratio 0.87, 95%

in the 1990s “showed that younger women with acute myocardial infarction had a higher mortality than men of similar age. Little is known about whether this gender difference has persisted over the years.” Dr. Radovanovic and colleagues set out to assess changes in in-hospital mortality of men and women with acute myocar- dial infarction over a 20-year period. The adjusted in-hospital mortality rate was cal- culated logistic regression analysis. Data were collected from 1997 through 2016 in the nationwide AcuteMyocardial Infarction in Switzerland registry (AMIS Plus). The study included 51,725 patients with acute myocar- dial infarction from83 Swiss hospitals. Among them, 30,398 (59%) presented with ST-seg- ment elevation myocardial infarction (STEMI) and 21,327 (41%) with non-ST-segment eleva- tion myocardial infarction (NSTEMI). The study population was 73% male (mean age 63.9 ± 12.8 years) and 27% female (mean age 71.7 ± 12.5 years). Womenwereolder than men in both the STEMI (71.3 ± 12.7 vs 62.8 ± 12.8 years, P < .001) and the NSTEMI group (72.2 ± 12.2 vs 65.6 ± 12.6 years, P < .001).

Dr. Radovanovic noted that women still experience higher in-hospital mortality from acute myocardial infarction than men, prob- ably because they are on average 8 years older when they suffer a heart attack, and they harbor more cardiovascular risk fac- tors and comorbidities. According to Dr. Radovanovic, although in-hospital mortality continues to be higher in women than men, overall age-adjusted mortality has decreased more prominently in women than men, particularly those younger than 60 years of age. The nar- rowing of the gender gap in mortality over the past 20 years may be due to increasing use of percutaneous coronary intervention (PCI) in women. The use of reperfusion to open blocked arteries, especially PCI, increased in all patients admitted for acute myocardial infarction. In STEMI patients, use of PCI increased from 60% to 93% in men and 45% to 90% in women.

PracticeUpdate Editorial Team

PRACTICEUPDATE CARDIOLOGY