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

Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST‐segment–elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization proced...

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Main Authors: Abdulla Shehab, Akshaya Srikanth Bhagavathula, Khalid F. Alhabib, Anhar Ullah, Jassim Al Suwaidi, Wael Almahmeed, Hussam AlFaleh, Mohammad Zubaid
Format: Article
Language:English
Published: Wiley 2020-02-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Subjects:
Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.119.013880
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author Abdulla Shehab
Akshaya Srikanth Bhagavathula
Khalid F. Alhabib
Anhar Ullah
Jassim Al Suwaidi
Wael Almahmeed
Hussam AlFaleh
Mohammad Zubaid
author_facet Abdulla Shehab
Akshaya Srikanth Bhagavathula
Khalid F. Alhabib
Anhar Ullah
Jassim Al Suwaidi
Wael Almahmeed
Hussam AlFaleh
Mohammad Zubaid
author_sort Abdulla Shehab
collection DOAJ
description Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST‐segment–elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in‐hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in‐hospital mortality, and 1‐year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age‐stratified analysis showed that younger women (aged <65 years) with STEMI were more likely to seek acute medical care and were less likely to receive thrombolytic therapies or primary percutaneous coronary intervention and guideline‐recommended pharmacotherapy than men. Women had higher crude in‐hospital mortality than men, driven mainly by younger age (46–55 years, odds ratio: 2.60 [95% CI, 1.80–3.7]; P<0.001; 56–65 years, odds ratio: 2.32 [95% CI, 1.75–3.08]; P<0.001; and 66–75 years, odds ratio: 1.79 [95% CI, 1.33–2.41]; P<0.001). Younger women had higher adjusted in‐hospital and 1‐year mortality rates than younger men (P<0.001). Conclusions Younger women (aged ≤65 years) with STEMI were less likely to receive guideline‐recommended pharmacotherapy and revascularization than younger men during hospitalization and had higher in‐hospital and 1‐year mortality rates.
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spelling doaj.art-f195294337fc4640b5cf154d777dc7d12023-03-13T05:25:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-02-019410.1161/JAHA.119.013880Age‐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 RegistriesAbdulla Shehab0Akshaya Srikanth Bhagavathula1Khalid F. Alhabib2Anhar Ullah3Jassim Al Suwaidi4Wael Almahmeed5Hussam AlFaleh6Mohammad Zubaid7Department of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab EmiratesDepartment of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab EmiratesDepartment of Clinical Sciences College of Medicine King Saud University Riyadh Saudi ArabiaDepartment of Clinical Sciences College of Medicine King Saud University Riyadh Saudi ArabiaDepartment of Cardiology and Cardiovascular Surgery Hamad Medical Corporation (HMC) Doha QatarCardiology Heart &amp; Vascular Institute Cleveland Clinic Abu Dhabi United Arab EmiratesDepartment of Clinical Sciences College of Medicine King Saud University Riyadh Saudi ArabiaDepartment of Medicine Faculty of Medicine Kuwait University KuwaitBackground No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST‐segment–elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in‐hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in‐hospital mortality, and 1‐year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age‐stratified analysis showed that younger women (aged <65 years) with STEMI were more likely to seek acute medical care and were less likely to receive thrombolytic therapies or primary percutaneous coronary intervention and guideline‐recommended pharmacotherapy than men. Women had higher crude in‐hospital mortality than men, driven mainly by younger age (46–55 years, odds ratio: 2.60 [95% CI, 1.80–3.7]; P<0.001; 56–65 years, odds ratio: 2.32 [95% CI, 1.75–3.08]; P<0.001; and 66–75 years, odds ratio: 1.79 [95% CI, 1.33–2.41]; P<0.001). Younger women had higher adjusted in‐hospital and 1‐year mortality rates than younger men (P<0.001). Conclusions Younger women (aged ≤65 years) with STEMI were less likely to receive guideline‐recommended pharmacotherapy and revascularization than younger men during hospitalization and had higher in‐hospital and 1‐year mortality rates.https://www.ahajournals.org/doi/10.1161/JAHA.119.013880acute coronary syndromehospitalizationMiddle Eastmortalitymyocardial infarctionsex
spellingShingle Abdulla Shehab
Akshaya Srikanth Bhagavathula
Khalid F. Alhabib
Anhar Ullah
Jassim Al Suwaidi
Wael Almahmeed
Hussam AlFaleh
Mohammad Zubaid
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
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
acute coronary syndrome
hospitalization
Middle East
mortality
myocardial infarction
sex
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic acute coronary syndrome
hospitalization
Middle East
mortality
myocardial infarction
sex
url https://www.ahajournals.org/doi/10.1161/JAHA.119.013880
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