Factors Influencing Major Cardiovascular Event Post Acute Myocardial Infarction in Woman

  • Siska Suridanda Danny Departement of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta, Indonesia
  • Poppy S Roebiono Departement of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta, Indonesia
  • Amiliana M Soesanto Departement of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta, Indonesia
  • Manoefris Kasim Departement of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta, Indonesia

Abstract

Background.Cardiovascular mortality had decreased significantly in men during the last 20 years but the decrease of mortality in women stayed more subtle. Age-group analysis toward this lack of decline showed that gender difference especially evident in subjects aged less than 55 years. This study aimed to investigate the rate of Major Adverse Cardiovascular Events (MACE) occurred in women after Acute Myocardial Infarction (AMI) and associated predictors, along with the differences in clinical characteristics between age groups which could potentially cause a disparity in outcome.
Methods.This was a retrospective cohort study by medical records analysis. We investigated female patients presenting to Emergency Departement National Cardiovascular Center Harapan Kita Jakarta (NCCHK) with AMI during January-December 2007. Investigation toward the occurrence of MACE was undertaken in February-March 2009.
Results.Female patients constituted 22.4% of all patients diagnosed as Acute Coronary Syndrome. There were a total of 168 patients with AMI, followed for 14-26 months (mean follow up time of 16.6 months). The incidence of MACE was 51.7%. Intra hospital mortality was 16.7% while overall mortality was 30.9%. Predictors for MACE were Diabetes Mellitus (DM) with HR 2.293 (95% CI: 1.099-4.783 p=0.027), and coronary lesion affecting 3 vessel/Left Main disease with HR 4.217 (95% CI: 1.907-9.280 p<0.001). Age-group analysis showed that in women more than 55 years of age, predictors of MACE included also DM and coronary lesion affecting 3 vessel/Left Main disease, along with history of previous angina. However, in women less than 55 years of age, the incident of MACE can not be predicted by clinical factors investigated by this study.
Conclusions.AMI in women poses a high rate of MACE and death in all age groups. AMI occurred in younger women constitutes a high risk group with different disease profile which is difficult to predict by traditional risk factors.

Downloads

Download data is not yet available.

References

Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: Concealed leveling of mortality rates. Journal of American College of Cardiology. 2007;50:2128-2132.

Manolio TA, Harlan WR. Research on coronary disease in women: political or scientific imperative? British Heart Journal. 1993;69:1-2.

Thomas JL, Braus PA. Coronary artery disease in women. A historical perspective. Archive of Internal Medicine. 1998;158:333-337.

Wenger NK. Clinical characteristics of coronary heart disease in women: emphasis on gender differences. Cardiovascular Research. 2002;53:558-567.

Foody JM. Women and coronary artery disease. In: Foody JM, ed. Preventive cardiology: Insights into the prevention and treatment of cardiovascular disease.2nd ed. New Jersey: Humana Press; 2006.

Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex based differences in early mortality after myocardial infarction. New England Journal of Medicine. 1999;341(4):17-25.

Vaccarino V, Krumholz HM, Yarzebski J, Gore JM, Goldberg RJ. Sex differences in 2-year mortality after hospital discharge for myocardial infarction. Annals of Internal Medicine. 2001;134:173-181.

Burke AP, Farb A, Malcolm GT, Liang Y-h, Smialek J, Virmani R. Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women. Circulation. 1998;97:2110-2116.

Borzak S, Weaver WD. Sex and outcome after myocardial infarction, a case of sexual politics? Circulation. 2000;102:2458-2459.

Garjito, Koey IN, Zaini M, Amana M, Irmalita. Faktor-faktor yang mempengaruhi prognosis MCI. Paper presented at: Kongres PERKI ke-V, 23-31 Oktober 1987; Jakarta.

Lundblad D, Holmgren L, Jansson J-H, Näslund U, Eliasson M. Gender differences in trends of acute myocardial infarction events: The Northern Sweden MONICA study 1985 – 2004. BMC Cardiovascular Disorders 2008, 8:17 doi:10.1186/1471-2261-8-17. 2008;8(17):1-10.

Apitule D. Beberapa faktor yang berkaitan dengan kematian di rumah sakit pada wanita dengan infark miokard akut (Tesis). Jakarta: Departemen Kardiologi dan Kedokteran Vaskular Departemen Kardiologi dan Kedokteran Vaskular. Fakultas Kedokteran Universitas Indonesia; 1995.

Hanratty B, Lawlor DA, Robinson MB, Sapsford RJ, Greenwood D, Hall A. Sex differences in risk factors, treatment, and mortality after acute myocardial infarction: an observational study. Journal of Epidemiology and Community Health. 2000;54:912-916.

Bonarjee VVS, Rosengren A, Snapinn SM, James MK, Dickstein K. Sex-based short- and long-term survival in patients following complicated myocardial infarction. Eur Heart J. 2006;27:2177-2183.

Dey S, Flather MD, Devlin G, Brieger D, Gurfinkel EP, Steg PG, et al. Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009;95:20-26.

Rosengren A, Spetz C-L, Ko¨ster M, Hammar N, Alfredsso L, Rose´n M. Sex differences in survival after myocardial infarction in Sweden: Data from the Swedish National Acute Myocardial Infarction register. Eur Heart J. 2001;22:314-322.

Jenkins JS, Flaker GC, Nolte B, Price LA. Causes of higher in-hospital mortality in women than in men after acute myocardial infarction. American Journal of Cardiology. 1994;73(5):319-322.

De-Luca G, Suryapranata H, Damrink J-H, Ottervanger JP, van’tHof AW, Ziljstra F, et al. Sex-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty: data from the Zwolle Myocardial Infarction Study. American Heart Journal. 2004;148(852-856).

Raine RA, Black NA, Bowker TJ, Wood DA. Gender differences in the management and outcome of patients with acute coronary artery disease. J Epidemiol Community Health. 2002;56:791-797.

Bedinghaus J, Leshan L, Diehr S. Coronary artery disease prevention: what’s different in women? American Journal of Family Physician. 2001;63:1393-1400.

Sowers JR. Diabetes mellitus and cardiovascular disease in women. Archive of Internal Medicine. 1998;158:617-621.

Ouyang P, Michos ED, Karas RH. Hormone replacement therapy and the cardiovascular system. Lessons learned and unanswered questions. Journal of the American College of Cardiology. 2006;47(9):1741-1753.

Post WS, Goldschmidt-Clermont PJ, Wilhide CC. Methylation of the estrogen receptor gene is associated with aging and atherosclerosis in the cardiovascular system. Cardiovascular Research. 1999;43:985-991.

Siniorakis E, Arvanitakis S, Voyatzopoulos G, Hatziandreou P, Plataris G, Alexandris A, et al. Hemodynamic classification in acute myocardial infarction: Has anything changed in the last 3 decades? CHEST 2000;117:1286-1290.

Widdershoven JWMG, Gorgels APM, Vermeer F, L. W. N. Dijkman, Verstraaten GMP, Dassen WRM, et al. Changing characteristics and in-hospital outcome in patients admitted with acute myocardial infarction:Observations from 1982 to 1994. Eur Heart J. 1997;18:1073-1080.

Hausenloy DJ, Yellon DM. Remote ischaemic preconditioning: underlying mechanisms and clinical application. Cardiovascular Research. 2008;79:377-386.

Solomon SD, Anavekar NS, Greaves S, Rouleau JL, Hennekens C, Pfeffer MA. Angina pectoris prior to myocardial infarction protects against subsequent left ventricular remodeling. Journal of American College Cardiology. 2004;43:1511-1514.

Kloner RA, Shook T, Przyklenk K, Davis VG, Junio L, Matthews RV, et al. Previous angina alters in-hospital outcome in TIMI 4: A clinical correlate to preconditioning? . Circulation. 1995;91:37-45.

Kloner RA, Shook T, Antman EM, Cannon CP, Przyklenk K, Yoo K, et al. Prospective temporal analysis of the onset of preinfarction angina versus outcome : An ancillary study in TIMI-9B. Circulation. 1042-1045 1998;97.
Views & Downloads
Abstract views: 2942   
PDF (Bahasa Indonesia) downloads: 2690   
How to Cite
Danny, S., Roebiono, P., Soesanto, A., & Kasim, M. (1). Factors Influencing Major Cardiovascular Event Post Acute Myocardial Infarction in Woman. Indonesian Journal of Cardiology, 30(1), 3-12. https://doi.org/10.30701/ijc.v30i1.171
Section
Clinical Research