#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Acute myocardial infarction in women


Authors: T. Janota
Authors‘ workplace: III. interní klinika 1. LF a VFN v Praze
Published in: Kardiol Rev Int Med 2006, 8(4): 198-201
Category: Editorial

Overview

Acute myocardial infarction (AMI) is one of the most frequent causes of death in women as well as in men. However, thanks to the delaying effects of estrogens before menopause on atherosclerosis development AMI is most prevalent in higher age groups than in men. Women with AMI are therefore older and suffer from a wider range of comorbidities like hypertension, diabetes, hyperlipidaemias and heart failure. Frequently, AMI in women lacks the typical textbook signs and symptoms, and coronary artery spasm plays larger role in aetiology of AMI. Different vegetative responses in women predispose to more marked and more frequent vagotonic reaction with hypotension and bradycardia. Women also seek medical attention later in the course of the illness. They are treated with less invasive methods and with higher rate of complications. However, after adjusting for age, women show only higher early mortality, especially in-hospital and in younger women. Women profit less from surgical revascularisation. The effects of thrombolytic and angioplastic treatments are similar to men after adjusting for age and other variables.

Key words:
acute myocardial infarction - women


Sources

1.Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association 2002; 288: 321-333.

2.Lemay A. The relevance of the Women's Health Initiative results on combined hormone replacement therapy in clinical practice. J Obstet Gynaecol Can 2002; 24: 711-715.

3.Manson JE, Bassuk SS, Harman SM et al. Postmenopausal hormone therapy: new questions and the case for new clinical trials. Menopause 2006; 13: 139-147.

4.Herrington DM, Reboussin DM, Klein KP et al. The estrogen replacement and atherosclerosis (ERA) study: study design and baseline characteristics of the cohort. Control Clin Trials 2000; 213: 257-285.

5.Vittinghoff E, Shlipak MG, Varosy PD et al. Risk factors and secondary prevention in women with heart disease: The Heart and Estrogen/progestin Replacement Study. Ann Intern Med 2003; 38: 81.

6.Toyofuku M, Goto Y, Matsumoto T et al. Acute myocardial infarction in young Japanese women. J Cardiol 1996; 28: 313-319.

7.Devon HA, Zerwic JJ. Symptoms of acute coronary syndromes: Are there gender differences? A review of the literature. Heart Lung 2002; 31: 235.

8.Hochman JS, Tamis-Holland JE. Acute coronary syndromes: Does gender matter? JAMA 2002; 288: 3161.

9.Blomkalns AL, Chen AY, Hochman JS et al. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/ American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol 2005; 45: 832-827.

10.Maynard C, Athouse R, Cerqueira M et al. Underutilization of thrombolytic therapy in eligible women with acute myocardial infarction. Am J Cardiol 1991; 68: 529-530.

11.Kyker KA, Limacher MC. Gender differences in the presentation and symptoms of coronary artery disease. Curr Womens Health Rep 2002; 2: 115.

12.Hayes SN, Gersh BJ. Chronic stable angina. In: Douglas PS. Cardiovascular Health and Disease in Women. 2nd ed. Philadelphia: WB Saunders 2002: 291-315.

13.Mosca L, Manson JE, Sutherland SE et al. Cardiovascular disease in women: A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 1997; 96: 2468.

14.Alexander KP, Shaw LJ, Shaw LK et al. Value of exercise treadmill testing in women. J Am Coll Cardiol 1998; 32: 1657.

15.Kim C, Kwok YS, Saha S et al. Diagnosis of suspected coronary artery disease in women: A cost-effectiveness analysis. Am Heart J 1999; 137: 1019.

16.Vakili BA, Kaplan RC, Brown DL. Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction. Circulation 2001; 104: 3034-3038.

17.Dittrich H, Gilpin E, Nicod P et al. Acute myocardial infarction in women: influence of gender on mortality and prognostic variables. Am J Cardiol 1988; 62: 1-7.

18.Grady D, Chaput L, Kristof M. Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics. Evidence Report/Technology Assessment No. 81. (Prepared by the University of California, San Francisco-Stanford Evidence-based Practice Center under Contract No 290-97-0013.) AHRQ Publication No. 03-0037. Rockville, Md, Agency for Healthcare and Research and Quality, May 2003.

19.Varma VK, Murphy PL, Hood WP et al for the Alabama Registry of Myocardial Ischemia Investigators: Are women with acute myocardial infarction managed differently from men? J Am Coll Cardiol 1992; 19: 20A.

20.De Jaegere P, Arnold AA, Balk AH et al. Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors. J Am Coll Cardiol 1992; 19: 289-294.

21.Woodfield SL, Lundergan CF, Reiner JS et al. Gender and acute myocardial infarction: Is there a different response to thrombolysis? JACC 1997; 29: 35-42.

22.Kaplan KL, Fitzpatrick P, Cox C et al. Use of thrombolytic therapy for acute myocardial infarction: Effects of gender and age on treatment rates. J Thromb Thrombolysis 2002; 13: 21.

23.Lincoff AM, Califf RM, Ellis SG et al. Thromobolytic Therapy for Women With Myocardial Infarction: Is There a Gender Gap? JACC 1993; 22: 1780-1787.

24.Ellis SG, Roubin GS, King SB et al. Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation 1988; 77: 372-379.

25.Lagerqvist B, Husted S, Kontny F et al. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet 2006; 16; 368: 998-1004.

26.Fox KA, Poole-Wilson P, Clayton TC et al. 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet 2005; 366: 914-920.

27.Cannon CP, Weintraub WS, Demopoulos LA et al. TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy) Thrombolysis in Myocardial Infarction 18 Investigators Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001; 344: 1879-1887.

28.Glaser R, Herrmann HC, Murphy SA et al. Benefit of an early invasive management strategy in women with acute coronary syndromes. JAMA 2002; 288: 3124.

29.Wallentin L, Lagerqvist B, Husted S et al. Outcome at 1 year after an invasive compared with a non-invasive strategy in unstable coronary-artery disease: The FRISC II invasive randomised trial. Fast Revascularisation during Instability in Coronary artery disease. Lancet 2000; 356: 9.

30.Vaccarino V, Lin ZQ, Kasl SV et al. Gender differences in recovery after coronary artery bypass surgery. J Am Coll Cardiol 2003; 41: 307.

31.Roth A, Elkayam U. Acute myocardial infarction and pregnancy. In: Elkayam U, Gleicher N. Cardiac Problems in Pregnancy. 3rd ed. New York: Wiley-Liss 1998: 131-151.

32.Hartel D, Sorges E, Carlsson J et al. Myocardial infarction and thromboembolism during pregnancy. Herz 2003; 28: 175-184.

33.Shivvers SA, Wians FH Jr, Keffer JH et al. Maternal cardiac troponin I levels during normal labor and delivery. Am J Obstet Gynecol 1999; 180: 122.

34.Hameed AB, Tummala PP, Godwin TM et al. Unstable angina during pregnancy in two patients with premature coronary atherosclerosis and aortic stenosis in association with familial hypercholesterolemia. Am J Obstet Gynecol 2000; 182: 1152.

35.Ginsberg JS, Hirsch J. Use of antithrombotic agents during pregnancy. Chest 1998; 114(Suppl): 524.

36.Sullebarger JT, Fontanet HL, Matar FA et al. Percutaneous coronary intervention for myocardial infarction during pregnancy: an new trend? J Invasive Cardiol 2003; 15: 725-728.

37.Ascarelli MH, Grider AR, Hsu HW. Acute myocardial infarction during pregnancy managed with immediate percutaneoustransluminal coronary angioplasty. Obstet Gynecol 1996; 88: 655-657.

38. Orencia A, Mailey K, Yawn BP, Kottke TE. Effect of gender on long-term outcomeof angina pectoris and myocardial infarction/sudden unexpected death. JAMA 1993; 269: 2392.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#