Sunday, October 21, 2012

Deadlier Than For The Male


Photo Credit – American Heart Association



# 6650


Although this blog deals primarily with emerging infectious diseases, this week is the 40th anniversary (Oct 1972) of my first job in EMS, and that ties nicely to an oral abstract presented at the 2012 Acute Cardiac Care Congress, which is being held this weekend in Istanbul, Turkey.


The subject is the impact of coronary heart disease on women, and differences in their symptoms and the treatment they receive. Their conclusion: Contrary to long held beliefs, heart attacks for women are deadlier than for the male.

At least in the cohort they studied. The abstract can be found at the link below: 



Are there gender differences in the management of ST-elevation myocardial infarction? Data from ORBI, a prospective registry of 5000 patients.

Guillaume LEURENT (Rennes, FR)



Note:  STEMIs are serious heart attacks that affect a large portion of cardiac muscle and show up on EKGs (ST segment elevation) and produce a spike in cardiac enzymes (indicative of muscle damage).


STEMI on EKG- credit



Fleshing out this abstract is a press release on the European Society of Cardiology’s website, from which I’ve excerpted portions below (bolding & Italics mine):


Women more likely to die from myocardial infarction than men

Gender gap in mortality is independent of patient characteristics, revascularisation delays and revascularisation modalities


Topics: Acute Coronary Syndromes (ACS)

Date: 20 Oct 2012

Doctors need to be more careful in the management of STEMI in women to further reduce ischemic time. This means adopting more aggressive reperfusion strategies and treating women the same as men. These actions by patients and doctors will reduce the current gender gap in mortality

Istanbul, Turkey – 20 October 2012: Women are more likely to die from a myocardial infarction than men, according to research presented at the Acute Cardiac Care Congress 2012.


The gender gap in mortality was independent of patient characteristics, revascularisation delays and revascularisation modalities. Women also had longer treatment delays, less aggressive treatment, more complications and longer hospital stays. The study was presented by Dr Guillaume Leurent from the Centre Hospitalier Universitaire in Rennes, France.




“Previous studies on ST elevation myocardial infarction (STEMI) have shown that women have a worse prognosis, possibly due to longer management delays and less aggressive reperfusion strategies,” said Dr Leurent. “Therefore we used data from ORBI, a prospective registry of 5,000 STEMI patients, to find out whether there were any gender differences in the management of STEMI.”




The researchers found significant differences in the management and outcome of STEMI patients according to gender.


Women had longer median delays between symptom onset and call for medical assistance (60 vs 44 minutes, p<0.0001) and between admission and reperfusion (45 vs 40 minutes, p=0.011).


“Delays of management are significantly longer in women, hence they have a longer ischemic time during which the heart’s blood supply is reduced,” said Dr Leurent. “And reperfusion strategies to restore blood flow are significantly less aggressive – with less fibrinolysis, and fewer coronary angiographies performed.”


Intra-hospital mortality was higher in women (9.0% vs 4.0%, p<0.0001). The researchers used 3 adjustment models to determine whether the higher intra-hospital mortality among women was solely due to gender or whether it was due to other factors such as patient characteristics (age, hypertension, smoking, etc) or management.

Dr Leurent said:



Women had more STEMI complications including atrial fibrillation (7% vs 3%, p<0.0001) and longer hospital stays (7.6+4 vs 6.7+4 days, p<0.0001).


Women received significantly less of the recommended treatments at discharge. Specifically, they received less antiplatelet agents, beta blockers, ACE inhibitors and statins. They also received less cardiovascular rehabilitation (27% of women vs 47% of men, p<0.0001).

(Continue . . .)



At the risk of stating the obvious, this study was based on 5000 STEMI patients followed into 9 coronary care units in the Brittany region of France since 2006. Time to treat, aggressiveness in treatment, and outcomes may (or may not) be typical of those seen in other places around the globe.


The belief that heart attacks were predominately a `male problem’ was widespread four decades ago. Back then, if a man (over 40) had chest pain, your first thought would be `heart attack’. If a woman of the same age had chest pain, your first thought was more apt to be `gall bladder”.


Since then we’ve learned that women certainly have their share of heart attacks, but they don’t always show the same classic symptoms (e.g. crushing chest pain radiating down the left arm, dyspnea, diaphoresis) that men usually do.


Which probably explains number of middle-aged women we saw who died abruptly at home without ever calling for help. They apparently chalked up whatever warning signs they had to indigestion, or some other minor ailment.


The American Heart Association’s article Heart Attack Symptoms in Women explains the differences.


“Although men and women can experience chest pressure that feels like an elephant sitting across the chest, women can experience a heart attack without chest pressure, ” said Nieca Goldberg, M.D., medical director for the Joan H. Tisch Center for Women's Health at NYU’s Langone Medical Center and an American Heart Association volunteer. “Instead they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue.”


Even when the signs are subtle, the consequences can be deadly, especially if the victim doesn’t get help right away.




Heart Attack Signs in Women

  1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
  2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  3. Shortness of breath with or without chest discomfort.
  4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you have any of these signs, don’t wait more than five minutes before calling for help. Call 9-1-1 and get to a hospital right away.


The following 3 minute film from Go Red for Women (starring Emmy-nominated actress Elizabeth Banks) illustrates the point nicely.




And finally, whether the victim is male or female - in the event of full cardiac arrest - having someone at hand with the skills to apply CPR can be lifesaving.


Luckily, today CPR is easier to do than ever.


Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.



While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.


A CPR class only takes a few hours, and it could end up helping you save the life of someone you love.


For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.


CPR As A Requirement For High School Graduation

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

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