Abstract:
BACKGROUND:Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era. METHODS AND RESULTS:Using the Get With the Guidelines-Coronary Artery Disease database, we examined sex differences in care processes and in-hospital death among 78 254 patients with AMI in 420 US hospitals from 2001 to 2006. Women were older, had more comorbidities, less often presented with ST-elevation myocardial infarction (STEMI), and had higher unadjusted in-hospital death (8.2% versus 5.7%; P<0.0001) than men. After multivariable adjustment, sex differences in in-hospital mortality rates were no longer observed in the overall AMI cohort (adjusted odds ratio [OR]=1.04; 95% CI, 0.99 to 1.10) but persisted among STEMI patients (10.2% versus 5.5%; P<0.0001; adjusted OR=1.12; 95% CI, 1.02 to 1.23). Compared with men, women were less likely to receive early aspirin treatment (adjusted OR=0.86; 95% CI, 0.81 to 0.90), early beta-blocker treatment (adjusted OR=0.90; 95% CI, 0.86 to 0.93), reperfusion therapy (adjusted OR=0.75; 95% CI, 0.70 to 0.80), or timely reperfusion (door-to-needle time =30 minutes: adjusted OR=0.78; 95% CI, 0.65 to 0.92; door-to-balloon time =90 minutes: adjusted OR=0.87; 95% CI, 0.79 to 0.95). Women also experienced lower use of cardiac catheterization and revascularization procedures after AMI. CONCLUSIONS:Overall, no sex differences in in-hospital mortality rates after AMI were observed after multivariable adjustment. However, women with STEMI had higher adjusted mortality rates than men. The underuse of evidence-based treatments and delayed reperfusion among women represent potential opportunities for reducing sex disparities in care and outcome after AMI.
journal_name
Circulationjournal_title
Circulationauthors
Jneid H,Fonarow GC,Cannon CP,Hernandez AF,Palacios IF,Maree AO,Wells Q,Bozkurt B,Labresh KA,Liang L,Hong Y,Newby LK,Fletcher G,Peterson E,Wexler L,Get With the Guidelines Steering Committee and Investigators.doi
10.1161/CIRCULATIONAHA.108.789800subject
Has Abstractpub_date
2008-12-16 00:00:00pages
2803-10issue
25eissn
0009-7322issn
1524-4539pii
CIRCULATIONAHA.108.789800journal_volume
118pub_type
杂志文章相关文献
CIRCULATION文献大全abstract:BACKGROUND:The Fick principle (cardiac output = oxygen uptake ( O2)/systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured O2 is commonly used because of complexities of the measurement, though the accuracy of estimation re...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.113.003334
更新日期:2014-01-14 00:00:00
abstract:BACKGROUND:There are few data regarding medium-term outcome of coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction, particularly in the modern era, and even less assessing preoperative factors that might identify patients at highest risk. METHODS AND RESULTS:Three ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.000661
更新日期:2006-07-04 00:00:00
abstract:BACKGROUND:The purpose of the present study was to investigate plasma lipid-independent mechanisms for the sex difference in the development of atherosclerosis. METHODS AND RESULTS:In the first experiment, 20 male and 20 female rabbits were balloon-injured in the middle thoracic aorta and maintained at the same plasma...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.98.24.2731
更新日期:1998-12-15 00:00:00
abstract:BACKGROUND:Extracellular matrix proteins, such as laminins, and endothelial cells are known to influence cardiomyocyte performance; however, the underlying molecular mechanisms remain poorly understood. METHODS AND RESULTS:We used a forward genetic screen in zebrafish to identify novel genes required for myocardial fu...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.689984
更新日期:2007-07-31 00:00:00
abstract:BACKGROUND:Heat shock proteins (HSPs) are well known for their ability to "protect" the structure and function of native macromolecules, particularly as they traffic across membranes. Considering the role of key mitochondrial proteins in apoptosis and the known antiapoptotic effects of HSP27 and HSP72, we postulated th...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000019403.35847.23
更新日期:2002-06-18 00:00:00
abstract:BACKGROUND:The cardiovascular adaptation to bed rest leads to orthostatic intolerance, characterized by an excessive fall in stroke volume (SV) in the upright position. We hypothesized that this large fall in SV is due to a change in cardiac mechanics. METHODS AND RESULTS:We measured pulmonary capillary wedge pressure...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.2.517
更新日期:1997-07-15 00:00:00
abstract:BACKGROUND:Dual antiplatelet therapy in older versus younger patients with acute coronary syndromes is understudied. Low-dose prasugrel (5 mg/d) is recommended for younger, lower-body-weight patients and elderly patients with acute coronary syndromes to mitigate the bleeding risk of standard-dose prasugrel (10 mg/d). ...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.113.002303
更新日期:2013-08-20 00:00:00
abstract::To define the prevalence, frequency and characteristics of premature ventricular complexes (PVCs) in adults free of recognizable heart disease, we performed 24-hour ambulatory electrocardiography on 101 subjects (51 men and 50 women, mean age 48.8 years) in whom physical examination, chest x-ray, ECG, echocardiogram, ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.63.6.1351
更新日期:1981-06-01 00:00:00
abstract:BACKGROUND:Perioperative management of patients with complete mixing of pulmonary and systemic blood centers on approximately equating pulmonary (Qp) and systemic (Qs) blood flow (Qp/Qs approximately 1). This empirically derived target is opposed by theoretical studies advocating a target Qp/Qs well below 1. We studied...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.21.2198
更新日期:1999-11-23 00:00:00
abstract:BACKGROUND:Coronary calcification detected by electron beam tomography may improve cardiovascular risk prediction. The technique is particularly promising in the elderly because the predictive power of cardiovascular risk factors weakens with age. We investigated the prognostic value of coronary calcification for cardi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.104.488916
更新日期:2005-07-26 00:00:00
abstract:BACKGROUND:The purpose of this investigation was to establish normal values of RR variability for middle-aged persons and compare them with values found in patients early and late after myocardial infarction. We hypothesized that presence or absence of coronary heart disease, age, and sex (in this order of importance) ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1161/01.cir.91.7.1936
更新日期:1995-04-01 00:00:00
abstract::To determine the effect of calcium-channel blockers on beta-adrenergic receptors, we studied the interactions of verapamil, diltiazem, and nifedipine with both human lymphocyte beta 2-adrenergic receptors and rat myocardial beta 1-adrenergic receptors by means of radioligand binding assays. We also determined the func...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.72.3.547
更新日期:1985-09-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to assess the long-term value of dobutamine-atropine stress echocardiography (DSE) for prediction of late cardiac events in patients with proven or suspected coronary artery disease. METHODS AND RESULTS:Clinical data and DSE results were analyzed in 1734 consecutive patients un...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.99.6.757
更新日期:1999-02-16 00:00:00
abstract:BACKGROUND:Evidence suggests that the vessel wall contains an oxidase similar, if not identical, to phagocytic NADPH oxidase. We tested the contribution of this specific oxidase to the progression of atherosclerosis and the regulation of blood pressure. METHODS AND RESULTS:An examination of aortic rings from wild-type...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.11.1234
更新日期:2000-03-21 00:00:00
abstract:BACKGROUND:Adrenomedullin (AM) is a vasodilating peptide involved in the regulation of circulatory homeostasis and in the pathophysiology of certain cardiovascular diseases. To determine the extent to which chronic AM overproduction affects circulatory physiology under normal and pathological conditions, we used a prep...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.19.2309
更新日期:2000-05-16 00:00:00
abstract::In studies to ascertain the basis of dynamic changes in the P wave, bipolar epicardial potentials were recorded from multiple atrial electrodes in dogs. One hundred to 120 activation times were displayed by a digital computer and used to construct atrial isotemporal activation sequence maps. Changes in heart rate or b...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.58.6.1036
更新日期:1978-12-01 00:00:00
abstract::Malperfusion of the thoracoabdominal aorta or its branches is a common complication of aortic dissection, often with a fatal outcome. Since 1985 we saw thoracoabdominal malperfusion in 13 patients with aortic dissection. During repair of an acute type A aortic dissection, the intimal flap was fenestrated in three case...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Analyses from randomized controlled trials suggest that bleeding in patients with acute myocardial infarction is associated with poor outcomes. Because these data are not generalizable to all patients with acute myocardial infarction, we sought to better understand the scope of this problem in a "real-world"...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.107.694273
更新日期:2007-12-11 00:00:00
abstract::Purine compounds modulate sympathetic neurotransmission; this modulation decreases nervous discharge by stimulating presynaptic inhibitory adenosine receptors, an effect antagonized by theophylline, and causes vasoconstriction through the stimulation of postsynaptic ATP receptors. In humans we evaluated the effect of ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.82.6.2061
更新日期:1990-12-01 00:00:00
abstract::Myocardial fiber disarray is a distinctive histopathologic finding seen in asymmetric hypertrophic cardiomyopathy. We studied 14 hearts with aortic atresia and intact interventricular septum, six hearts with pulmonic atresia and intact interventricular septum, eight normal infant hearts matched for age of the study he...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.67.1.191
更新日期:1983-01-01 00:00:00
abstract:BACKGROUND:Whether and to what extent complement is activated in acute myocardial infarction (AMI) and how it contributes to inflammation of the ischemic area are not yet clear. Fibrinolytic agents used for thrombolysis are known to activate complement in vitro and may contribute to its activation in vivo. The aim of t...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.89.1.76
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Erosion and rupture of coronary atheromas are the events preceding the vast majority of acute coronary syndromes. The shoulder regions of atheromas, the sites at which erosion or rupture is most likely to occur, are the sites at which mast cells accumulate. These cells are filled with neutral proteases capab...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.92.5.1084
更新日期:1995-09-01 00:00:00
abstract::The hypothesis tested in this study was that despite the presence of severe postischemic myocardial dysfunction ("stunning"), the extraction and subsequent intracellular washout of thallium 201 should be preserved as long as irreversible sarcolemmal membrane injury was avoided. To produce myocardial stunning, 19 open-...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.81.5.1622
更新日期:1990-05-01 00:00:00
abstract:BACKGROUND:The results of angiographic studies have suggested that calcium channel-blocking agents may prevent new coronary lesion formation, the progression of minimal lesions, or both. METHODS AND RESULTS:The Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) was a multicenter, rand...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1161/01.cir.102.13.1503
更新日期:2000-09-26 00:00:00
abstract:BACKGROUND:Risk factors for obstructive sleep apnea (OSA) and the development of subsequent cardiovascular (CV) complications differ by sex. We hypothesize that the relationship between OSA and high-sensitivity troponin T (hs-TnT), cardiac structure, and CV outcomes differs by sex. METHODS AND RESULTS:Seven hundred fi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.115.016985
更新日期:2015-10-06 00:00:00
abstract:BACKGROUND:In patients with symptoms of heart failure, elevations in B-type natriuretic peptide (BNP) accurately identify ventricular dysfunction. However, BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000103681.04726.9C
更新日期:2003-12-16 00:00:00
abstract::Cross-sectional echocardiographic studies of the aortic arch and proximal descending aorta were performed in 18 patients with coarctation of the aorta and 20 normal subjects. In normals the aortic arch and proximal descending aorta appeared as an arcuate, echo-free structure curving across the plane of the scan. There...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.57.3.498
更新日期:1978-03-01 00:00:00
abstract:BACKGROUND:Whether cardiac rehabilitation (CR) is effective in patients older than 75 years, who have been excluded from most trials, remains unclear. We enrolled patients 46 to 86 years old in a randomized trial and assessed the effects of 2 months of post-myocardial infarction (MI) CR on total work capacity (TWC, in ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.CIR.0000066322.21016.4A
更新日期:2003-05-06 00:00:00
abstract::Background: In ISCHEMIA, an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality compared with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.120.047987
更新日期:2020-12-03 00:00:00
abstract:BACKGROUND:High-altitude pulmonary edema (HAPE) is characterized by pulmonary hypertension, increased pulmonary capillary permeability, and hypoxemia. Treatment is limited to descent to lower altitude and administration of oxygen. METHODS AND RESULTS:We studied the acute effects of inhaled nitric oxide (NO), 50% oxyge...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.98.22.2441
更新日期:1998-12-01 00:00:00