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Significance of the invasive strategy after acute myocardial infarction on prognosis and secondary preventive medication: a nationwide study of 6364 women and 11,915 men.
- Source :
-
The Journal of invasive cardiology [J Invasive Cardiol] 2012 Jan; Vol. 24 (1), pp. 19-24. - Publication Year :
- 2012
-
Abstract
- Objective: To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI).<br />Design: Observational cohort study.<br />Setting: Nationwide registries.<br />Patients: We included 18,279 patients: 6364 women (35%) and 11,915 men (65%), admitted with AMI (median age, 67 years; range, 30-90 years) surviving for at least 2 months.<br />Interventions: According to sex, patients were stratified by invasive treatment strategy: (1) revascularized; (2) examined with coronary angiography (CAG) but not revascularized; and (3) not examined with CAG.<br />Main Outcome Measures: All-cause mortality and readmission with AMI. Initiation of secondary preventive medication.<br />Results: Of 18,279 patients with a first AMI who survived 2 months, 1857 women (29%) and 1756 men (15%) were not examined with CAG (P<.001), 1295 women (20%) and 1563 men (13%) were examined but not revascularized (P<.001), and 3212 women (51%) and 8596 men (72%) were revascularized (P<.001). Not being examined with CAG after AMI was associated with a three-fold increase in risk of death and, importantly, a 50% increase in the risk of a recurrent AMI compared with patients who were revascularized. Among patients who were revascularized, 85-92% initiated recommended secondary preventive medication compared to 46-71% in patients not examined with CAG (P<.001). Initiation of secondary preventive medication was higher in men (81-84%) than in women (73-79%; P<.001), which could be ascribed to the differences in invasive strategy.<br />Conclusions: In both sexes, those who were not examined had a highly increased risk of both recurrent AMI and death. Moreover, initiation of secondary preventive medication was closely related to the choice of invasive strategy disfavoring the women.
- Subjects :
- Adult
Aged
Aged, 80 and over
Cohort Studies
Denmark
Female
Humans
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction mortality
Outcome Assessment, Health Care
Prognosis
Recurrence
Registries
Survival Rate
Treatment Outcome
Angioplasty, Balloon, Coronary
Coronary Angiography
Coronary Artery Bypass
Myocardial Infarction diagnosis
Myocardial Infarction therapy
Secondary Prevention
Sex Characteristics
Subjects
Details
- Language :
- English
- ISSN :
- 1557-2501
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of invasive cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 22210585