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Differences in clinical characteristics in patients with first ST-segment elevation myocardial infarction and ventricular fibrillation according to sex

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

We aimed to assess sex differences in clinical characteristics, circumstances of arrest, and procedural characteristics in ST-elevation myocardial infarction (STEMI) patients with ventricular fibrillation (VF) prior to angioplasty.

Methods

Cases of VF with first STEMI (n = 329; 276 men and 53 women) were identified from the GEVAMI study, which is prospectively assembled case-control study among first STEMI patients in Denmark.

Results

Compared to men, women experienced symptoms for a longer time interval prior to angioplasty (140 vs. 166 min, p = 0.020), and were more likely to present with VF later during transport to the hospital rather than prior to emergency medical services arrival (36 vs. 52%, p = 0.040). Prior to VF, women had a significantly lower income (p = 0.002) and education level (p = 0.008), were less likely to consume alcohol (3 vs. 6 units, p = 0.040), more likely to smoke (71 vs. 52%, p = 0.007), and more likely to have depression (25 vs. 10%, p = 0.002) or a history of angina (59 vs. 42%, p = 0.030). Even though women had more angina within a year prior to VF, no difference was observed in self-reported contact with the healthcare system (p = 0.200). In multivariable logistic regression models, history of angina (OR = 2.70; p = 0.006), low educational level (OR = 2.80, p = 0.012) and low income (OR = 6.00, p = 0.005) remained significantly associated with female sex. There were no differences in procedural characteristics between men and women.

Conclusions

We found several sex differences in clinical characteristics and circumstances of arrest. The importance of seeking acute medical attention when experiencing angina should be emphasized in women, especially in women with low socioeconomic status.

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Acknowledgements

This study was supported by research grants from the Novo Nordisk, The Research Foundation of the Heart Centre at Rigshospitalet, and The Research Foundation of the University Hospital of Copenhagen, Rigshospitalet. We acknowledge the support from different institutions.

Funding

This study was supported by research grants from the Novo Nordisk Foundation to Dr. Tfelt-Hansen, The Research Foundation of the Heart Centre at Rigshospitalet, and The Research Foundation of the University Hospital of Copenhagen, Rigshospitalet. This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381.

Author information

Author notes

  1. Reza Jabbari, Charlotte Glinge, Thomas Engstrøm, and Jacob Tfelt-Hansen contributed equally to this work

Authors and Affiliations

  1. Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 9441, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Reza Jabbari, Charlotte Glinge, Bjarke Risgaard, Thomas Hadberg Lynge, Bo Gregers Winkel, Stig Haunsø, Thomas Engstrøm & Jacob Tfelt-Hansen

  2. Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Juliane Mariesvej 20, 2100, Copenhagen Ø, Denmark

    Stig Haunsø

  3. Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Christine M. Albert

Authors
  1. Reza Jabbari
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  2. Charlotte Glinge
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  3. Bjarke Risgaard
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  7. Christine M. Albert
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  9. Jacob Tfelt-Hansen
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Corresponding author

Correspondence to Reza Jabbari.

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The authors declare that they have no conflict of interest.

Additional information

What is already known about this subject?

• Ventricular fibrillation (VF) and sudden cardiac death (SCD) are still leading causes of death in patients with ST-segment elevation myocardial infarction (STEMI). Although the incidence of SCD increases with age in both genders, the annual rate of SCD among women is about half that of men, even after adjusting for coronary artery disease (CAD) risk factors. However, the underlying reasons for the sex difference are poorly understood and are based on limited data but do suggest that SCD may be a more complex disorder in women compared with men.

What does this study add?

• Our study is the first study to investigate sex differences in clinical characteristics, circumstances of arrest, and procedural characteristics of patients with first STEMI and VF prior to angioplasty. Using a Danish multicenter prospectively assembled case-control study, we identified several clinically specific differences between women and men including the following:

- Compared to men, women tended to be current smokers, to experience more angina within a year prior to VF, to have a history of depression, and to have a lower socioeconomic status.

- Even though women were more likely to experience angina within a year prior to VF, no difference was observed in self-reported contact with the healthcare system due to cardiac symptoms.

- Compared to men, women experienced symptoms for a longer time interval prior to acute angioplasty and were more likely to present with VF later during transport to the hospital rather than prior to emergency medical services arrival.

- Traditional cardiovascular risk factors did not differ and there were no differences in procedural characteristics between men and women.

- Using an adjusted logistic regression model to assess factors associated with the female sex, we identified angina, low educational level, and low income to be associated with the female sex.

How might this impact on clinical practice?

• In this study, we found several sex differences in clinical characteristics and circumstances of arrest. Our findings indicate that women are less likely than men to contact the healthcare system when they experience angina. The importance of seeking acute medical attention when experiencing angina should be emphasized in women especially in women with low socioeconomic status.

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Jabbari, R., Glinge, C., Risgaard, B. et al. Differences in clinical characteristics in patients with first ST-segment elevation myocardial infarction and ventricular fibrillation according to sex. J Interv Card Electrophysiol 50, 133–140 (2017). https://doi.org/10.1007/s10840-017-0284-0

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  • DOI: https://doi.org/10.1007/s10840-017-0284-0

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