SPC365

Gender Disparities in Acute Myocardial Infarction – Still an Unsolved Puzzling Issue

Session: Posters (Sessão 5 - Écran 1) - DAC e Cuidados Intensivos 6 - MINOCA, género e idade
Speaker: Catarina Amaral Marques

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Catarina Amaral Marques; André Cabrita; Paulo Maia Araújo; Tânia Proença; Ricardo Pinto; Miguel Carvalho; Catarina Costa; Filipa Amador; João Calvão; Ana Pinho; Cátia Santos; Luís Santos; Cristina Cruz; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Background: </span></strong><span style="color:black">Gender differences in acute myocardial infarction (AMI) have been widely described, namely longer time delays, less access to revascularization and worse outcomes for women (W). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Purpose: </span></strong><span style="color:black">To<strong> </strong>characterize current gender differences regarding<strong> </strong>presentation, time delays, treatment and outcomes in AMI, as well as explore gender influence in patients (pts) behavior and knowledge about AMI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> In this 6-month prospective study of pts admitted in a tertiary hospital due to type-1 AMI, 196 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured&nbsp;interview within 48h after admission and review of medical records. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Results: </span></strong><span style="color:black">A total of&nbsp;42W (21%) were included.&nbsp;Non-ST/ST Segment Elevation Myocardial Infarction (NSTEMI/STEMI)&nbsp;proportion&nbsp;was similar between genders (49%/51%, respectively, and&nbsp;</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">considering all pts), as well as age distribution (overall mean of 62</span><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span><span style="color:black">13 years). More men (M) had a previous history of AMI (23% vs 10%; p=0,05) and of percutaneous revascularization (17% vs 5%; p=0,05). At least 1 cardiovascular risk factor (CVRF) was equally identified (W:95%; M:98%). Typical chest pain was reported similarly (W:95%; M:94%), as well as pain intensity (0-10 </span>scale):<span style="color:black"> 75%W and 71%M with chest pain intensity&nbsp;equal or greater than&nbsp;</span><span style="color:black">6. W presented more associated symptoms (79% vs 60%; p=0,02).<strong> </strong>Coronary angiography (W:100%; M:97%) and revascularization (W:78%; M:80%) were equally performed. AMI-complications were more frequent in W (43% vs 23%; p=0,009), with a trend to have more often cardiogenic shock (14% vs 5%; p=0,08), and significantly more reinfarction (12% vs 2%; p=0,01) and atrial fibrillation (17% vs 5%; p=0,02). In-hospital mortality was, however, not significantly different (W:5%; M:2%; p=0,3). W had a longer hospital stay (W:7</span><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span><span style="color:black">7 days (d); M:5</span><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span><span style="color:black">4 d; p=0,03). No significant differences were found regarding time delays (table 1). Curious differences were detected in pts behavior and knowledge about AMI: W were less confident about their knowledge of AMI symptoms (45% vs 65%; p=0,02), although it didn&rsquo;t translate into differences in perceiving their symptoms as AMI (W:21%; M:32%). W were more prudent, being less likely to drive with chest pain (5% vs 18%; p=0,04). &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Conclusion: </span></strong><span style="color:black">Our study shows&nbsp;no significant gender differences in time delays or access to myocardial revascularization. Although our data suggest&nbsp;an increased awareness and improved care of W with AMI, W still presented worse outcomes. It would be of extreme importance to better represent W data in AMI studies and guidelines to improve their outcomes.</span></span></span></span></p>