MDNews - Greater Kansas

+++++++++++++++++++++++++++++ +++ +++ +++++++++++++++++++++++++++++ CARDIOLOGY SPOTLIGHT + + The Persistence of a Gender Gap for STEMI Sufferers WHEN IT COMES TO HEART ATTACK, MEN'S AND WOMEN'S EXPERIENCES DIFFER IN MORE THAN JUST SYMPTOMS, ESPECIALLY WITH REGARD TO TREATMENT AND OUTCOMES INVOLVING THE MOST SERIOUS TYPE OF HEART ATTACK: ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI). T HE BEGINNING OF the 21st century witnessed a shift in the preferred treatment method for STEMI, a type of heart attack characterized by prolonged blockage of an artery that affects a significant portion of the heart. The most effective treatment for STEMI is to reopen the obstructed vessel and allow blood flow to resume — a strategy known as reperfu- sion. Prior to approximately 2000, the preferred method of reperfusion was the use of fibrinolytic drugs to break down obstructions. During the last decade, however, a shift away from this method of reperfusion occurred. Coronary artery catheteriza- tion with primary percutaneous coro- nary intervention (PCI) now holds sway as the dominant reperfusion technique. During the fibrinolytics era, studies revealed women possessed a higher risk of bleeding and death than men, and women also received reperfu- sion less often. The authors of a recent Swedish study theorized that reperfusion rates for women would have increased since primary PCI came to prominence. Troubling Findings To explore this, the study authors scrutinized 30,077 patients during two periods — 15,697 during 1998 to 2000 when fibrinolytics were generally the reperfusion method of choice and 14,380 from 2004 to 2006 when primary PCI was the dominant reperfusion technique; women represented 35% of patients during each inclusion period. The study found that 9% of patients received primary PCI from 1998 to 2000 while 68% were treated with the method from 2004 to 2006. Cont r a r y to the researchers' hypothesis, the gender gap in treatment and mortality between male and female STEMI sufferers increased rather than diminished when they compared the two inclusion periods. During the fibrinolytics-dominated period, 63.1% of women received reperfusion compared to 70.9% of men. The primary PCI era revealed little increase in women treated with the technique — 63.6% of women received primary PCI, while the number of men treated with the same method increased more than 4% to 75.3%. Even after researchers adjusted for higher age and comorbidity, women still stood a 20% less chance of receiving primary PCI during 2004 to 2006. The study also uncovered more bad news for women with the revelation that they were less likely than men to receive other evidence-based treatments during both inclusion periods, with the gender gap for some therapies actually widening between the periods. The researchers did not hypothesize about the causes of the gender gap's persistence and increase, but they sug- gested — despite increased adherence to guidelines regarding the diagnosis and treatment of female STEMI pat ient s in recent years — that paying even more a t t e n t i o n t o guidelines would likely increase the prognosis for women with STEMI. n MDNEWS.COM n MD NEWS Greater Kansas | 9

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