Medical Device Daily
ATLANTA — When it comes down to the rate at which men and women survive heart attacks and other cardio illnesses, there is a huge discrepancy between the two groups. A recent study shed more light on this discrepancy and revealed that women are more likely to survive a heart attack if they received the same level of therapy as males.
The multicenter study findings were presented during last week's American College of Cardiology's (ACC; Washington) 59th annual scientific session, and shows that women are far less likely to go to the cardiac catheterization laboratory for angiography or angioplasty and about twice as likely to die within a month of having the heart attack.
“This suggests that we could reduce mortality in female patients by using more invasive procedures [on women],“ said Francois Schiele, MD, professor of cardiology and cardiology chief at the University Hospital of Besancon (France). “When there are no clear contraindications, women should be treated with all recommended strategies, including invasive strategies.“
For the study, researchers analyzed data from a regional registry that included all patients treated for a heart attack between January 2006 and December 2007. Of the 3,510 patients in the study, 1 , 1 19 (32%) were women.
A comparison of raw data showed that women were, on average, nine years older than men, had more health problems, received fewer effective treatments for heart attack, and were nearly twice as likely to die, both during the initial hospital stay (9.7% vs. 5%) and throughout the following month (12.4% vs. 7%).
In previous studies the reason for a woman's higher risk of death after a heart attack has been unclear. According to Schiele, possible explanations include biological differences in the atherosclerotic process and clinical differences when the heart attack occurs – such as women tend to be older and have poorer overall health.
“There is also a tendency from physicians to hold off on such invasive procedures because women have smaller arteries, a smaller anatomy,“ Schiele said during a press conference at the meeting last week.
To obtain data, researchers used a statistical method known as propensity score matching that tries to reduce bias of treatment-effect estimates from observational studies, to create pairs of men and women closely matched according to baseline characteristics. According to study results this created a population of 1,298 patients composed of 649 pairs. A second population of matched pairs was created by taking into account not only baseline characteristics but also the treatments and strategies actually used for each patient. This population of 584 pairs represented 1, 1 68 patients.
When the researchers analyzed data from the first 649 pairs, they found that despite very similar clinical characteristics, men were 57% more likely than women to undergo coronary angiography.
Among patients who had an especially serious form of heart attack known as ST-elevation myocardial infarction, men were far more likely than women to receive therapy to reopen the blocked artery, whether by clot-busting drugs (used 72% more often in men) or by angioplasty (used 24% more often in men). The death rate during the initial hospital stay was 48% lower in men than in women, and the death rate within 30 days of the heart attack was about 30% lower in men, although this last finding was of borderline statistical significance.
When researchers analyzed the second set of 584 pairs, matched on both clinical characteristics and treatments, there were no longer any statistically significant differences in mortality between genders, either in-hospital or at 30 days.
Schiele said that now physicians have to take this information and make better inroads to communicating with female patients and that this should be an opportunity for greater patient awareness.
Omar Ford 404-262-5546;
Published: March 19, 2010