The Society for Cardiovascular Angiography and Interventions
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ID: A-042
Session Title/Time/Location:
Poster Session A/Wednesday, May 28, 2014, 1:00 pm-4:00 pm (Pacific Time)/Exhibition Hall
Trends in Myocardial Infarction and In-Hospital Outcomes in
Women <55 Years Old in the United States, 2007-2011
Category: Acute Coronary Syndromes, Myocardial Infarction, Thrombectomy and Vulnerable
Plaque
Authors: Luke Kim, New York Presbyterian Hospital, Cornell Campus, United States; Dmitriy
Feldman, New York Presbyterian Hospital, Cornell Campus, United States; Rajesh
Swaminathan, New York Presbyterian Hospital, Cornell Campus, United States; Robert
Minutello, New York Presbyterian Hospital, Cornell Campus, United States; Robert Minutello,
New York Presbyterian Hospital, Cornell Campus, United States; Geoffrey Bergman, New York
Presbyterian Hospital, Cornell Campus, United States; Harsimran Singh, New York Presbyterian
Hospital, Cornell Campus, United States; David Yang, New York Presbyterian Hospital, Cornell
Campus, United States; Konstantinos Charitakis, New York Presbyterian Hospital, Cornell
Campus, United States; Ashish Shah, New York Presbyterian Hospital, Cornell Campus, United
States; Shing Chiu Wong, New York Presbyterian Hospital, Cornell Campus, United States
Background: The frequency of myocardial infarction (MI) has been declining over time
concurrently with the improvement in medical therapy for CAD. However, recent reports
outside US suggest increasing admission rates for MI in younger women. Prior findings from
U.S., as well as Europe, also report less frequent use of reperfusion therapy in female patients.
We sought to assess trends in MI and associated in-hospital outcomes in women <55 years old
in U.S. from 2007 to 2011.
Methods: We analyzed all patients <55 years old admitted with diagnosis of acute MI from
2007-2011 in the Nationwide Inpatient Sample database. Temporal trends as well as rates of
adverse in-hospital outcomes (death, stroke, bleeding, vascular complications, and acute renal
failure (ARF)) were examined. Multivariate propensity-score adjusted analysis was performed
to compare outcomes in female vs. male patients.
Results: From 2007-2011, there was no significant change in the rate of acute MI in both male
and female cohorts. Although there was a decline in the rate of ST-elevation (STEMI) in those
≥55 years old, the rate remains steady in patients <55 years old, especially in the female
cohort. Female patients <55 years old with MI (n= 13,009) were more likely to have diabetes,
hypertension, chronic renal insufficiency, peripheral vascular disease, congestive heart failure
and obesity than male patients (n=42,444). Female patients were more likely to present with
non–STEMI vs. STEMI and more likely to develop shock complicating their MIs. Female patients
were less likely to undergo coronary artery revascularization including PCI and CABG.
Unadjusted risk of death was higher in female vs male (5.2% vs. 3.7%, p<0.001) along with
higher incidence of stroke (0.5% vs. 0.3%, p<0.001), bleeding (4.9% vs. 3.0%, p<0.001), vascular
complication (0.6% vs. 0.4%, p<0.001) and ARF (11.6% vs. 9.6%, p<0.001). After adjustment,
death (OR 1.10, 95%CI 1.04-1.17), stroke (OR 1.31, 95%CI 1.10-1.55), bleeding (OR 1.30, 95%CI
1.22-1.37), and vascular complications (OR 1.33, 95%CI 1.15-1.55) were all significantly higher
for female cohort.
Conclusions: While incidence of MIs has decreased in older [≥ 55 years old] and in males in
general during the study period, the rate of MIs remains stable in younger [<55 year old]
female patients. Importantly, compared to male cohorts female patients have more frequent
adverse clinical characteristics, are less likely to undergo coronary revascularization
procedures and have less favorable clinical outcomes.
Author Disclosures:
1. Luke Kim: This author has nothing to disclose.
2. Dmitriy Feldman: This author has nothing to disclose.
3. Rajesh Swaminathan: This author has nothing to disclose.
4. Robert Minutello: This author has nothing to disclose.
5. Robert Minutello: This author has nothing to disclose.
6. Geoffrey Bergman: This author has nothing to disclose.
7. Harsimran Singh: This author has nothing to disclose.
8. David Yang: This author has nothing to disclose.
9. Konstantinos Charitakis: This author has nothing to disclose.
10. Ashish Shah: This author has nothing to disclose.
11. Shing Chiu Wong: This author has nothing to disclose.