 |
|
Studies may show how to close the gap between women and men who suffer heart attacks
May 07, 2009Age, condition and treatment delay are among the reasons women who undergo angioplasty for heart attack often do not fare as well as do men, according to two studies presented today at the Society for Cardiovascular Angiography and Interventions (SCAI) 32nd Annual Scientific Sessions. These studies, which are among the first to document outcomes in female patients treated with angioplasty and stenting for a heart attack, may help close the outcome gap between women and men.
The studies found, when compared with their male counterparts, women undergoing angioplasty for heart attack are often older (by an average of nine years), in poorer condition (such as suffering from diabetes) and have a longer onset due to delayed recognition of symptoms by both patients and their caregivers. In addition, women are less likely to develop brisk blood flow through the treated artery after percutaneous coronary intervention (PCI). As a result, women face twice the likelihood of procedural failure and an increased risk of death, according to the studies.
The studies show many people do not understand that female heart attack patients often present differently than men. Although women, like men, can experience chest pain or discomfort during a heart attack, women are somewhat more likely to have other symptoms instead, such as shortness of breath, nausea/vomiting and back or jaw pain.
"Women who have chest pain due to a heart attack often attribute it to other reasons and, therefore, come to the hospital later than men," said Itsik Ben-Dor, M.D., an interventional cardiology fellow at Washington Hospital Center in Rockville, MD. "The procedure is harder and the success rate is lower in women partly because the time is longer from the onset of symptoms to treatment with PCI."
Angioplasty and stenting are highly successful procedures for treating a heart attack, thanks to impressive improvements in devices, techniques, medications, and rapid treatment protocols.
In PCI, an interventional cardiologist makes a small puncture in the groin and introduces a slender tube, or catheter, into the femoral artery. The catheter is threaded up through the aorta and into the arteries that supply blood to the heart. After removal of the blood clot that is responsible for the heart attack, the cardiologist positions a small balloon across the remaining blockage and inflates the balloon to widen the artery. Another balloon with a stent crimped on it is positioned across the lesion and inflated, expanding and releasing the tiny metal tube that will act as scaffolding to keep the artery open.
In the first study, Dr. Ben-Dor and his colleagues analyzed data from 1,853 patients who had a type of heart attack known as ST-elevation myocardial infarction (STEMI) and were treated with PCI between 2000 and 2008. The overall success rate was 96.2%. When researchers analyzed characteristics that were independently linked to procedural failure, they found the most ominous to be lesions that were complex, calcified, widespread, or difficult-to-treat. These unfavorable characteristics hiked the risk of failure nearly fourfold. Simply being female increased the odds of procedural failure by a factor of 2.04.
PCI failure also resulted in significantly higher rates of death during the initial hospitalization (17.8% vs. 3.2%; p<0.001) and over the following year (44.7% vs. 13.0%, p<0.001). After PCI failure, patients were also more likely to suffer another heart attack within a year (20.0% vs. 8.1%, p=0.05) and to need a repeat procedure to open the artery blocked during the heart attack (23.1% vs. 8.3%, p=0.02).
Dr. Ben-Dor and his colleagues are continuing to investigate why women are at a disadvantage in heart attack PCI. They are currently analyzing some 800 arterial x-rays, or angiograms, taken in men and women experiencing a heart attack. The angiograms will help determine whether the explanation lies in the location of the obstructing lesion, or in lesion characteristics such as calcification, length, the number of twists and turns in the obstructed artery, and the amount of the blood clot blocking the artery.
For the second study, researchers at Zhongshan Hospital in Shanghai analyzed data from 692 consecutive patients who had a STEMI heart attack and were treated with PCI. Of these, 142 were women and 550 were men. Overall, 63% of patients were considered elderly (older than 60 years), but the proportion was much higher in women than in men (88.5% vs.56.5%, p=0.000). The average age of female patients was 71.1 years, as compared to 62.4 years for men (p=0.000). Women were also more likely to be diabetic (26.6% vs.18.4%, p=0.03). Rates of multivessel disease were similar in the two groups, as was the specific location of the arterial blockage that caused the heart attack. Other features, however, made PCI more challenging in women.
"In clinical practice, older females have more three-vessel disease, more calcified or tortuous lesions, and the arteries are smaller," said Junbo Ge, MD, a professor of medicine at Fudan University; director of cardiology at Zhongshan Hospital; and co-chairman of the Shanghai Institute of Cardiovascular Diseases, all in Shanghai, China. "All of these characteristics create technical difficulties and challenges in performing PCI in women, easily causing more complications and suboptimal results."
Indeed, Dr. Ge and his colleagues found that PCI was less successful in restoring full blood flow through the treated artery in women than in men, as indicated by the average "TIMI" score (2.8 vs. 2.9, p=0.048). In addition, women required a longer hospital stay (14.5 days vs.12.4 days, on average, p=0.02). The rates of serious complications, such as stroke, major bleeding and repeat heart attack during the initial hospitalization were similar in the two groups, but the in-hospital death rate in women was significantly higher, 12.8% vs. 5.4% in men, p=0.003.
The investigators concluded the survival disadvantage among women might be explained by their older age and less desirable PCI results.
"We need a large prospective study to confirm these findings and to determine why the final TIMI flow through the coronary artery was worse in female patients," Dr. Ge said. "Also, we should use new therapies, PCI devices, and strategies to further improve survival in women."
Society for Cardiovascular Angiography and Interventions
"Women who have chest pain due to a heart attack often attribute it to other reasons and, therefore, come to the hospital later than men," said Itsik Ben-Dor, M.D., an interventional cardiology fellow at Washington Hospital Center in Rockville, MD. "The procedure is harder and the success rate is lower in women partly because the time is longer from the onset of symptoms to treatment with PCI."
Angioplasty and stenting are highly successful procedures for treating a heart attack, thanks to impressive improvements in devices, techniques, medications, and rapid treatment protocols.
In PCI, an interventional cardiologist makes a small puncture in the groin and introduces a slender tube, or catheter, into the femoral artery. The catheter is threaded up through the aorta and into the arteries that supply blood to the heart. After removal of the blood clot that is responsible for the heart attack, the cardiologist positions a small balloon across the remaining blockage and inflates the balloon to widen the artery. Another balloon with a stent crimped on it is positioned across the lesion and inflated, expanding and releasing the tiny metal tube that will act as scaffolding to keep the artery open.
In the first study, Dr. Ben-Dor and his colleagues analyzed data from 1,853 patients who had a type of heart attack known as ST-elevation myocardial infarction (STEMI) and were treated with PCI between 2000 and 2008. The overall success rate was 96.2%. When researchers analyzed characteristics that were independently linked to procedural failure, they found the most ominous to be lesions that were complex, calcified, widespread, or difficult-to-treat. These unfavorable characteristics hiked the risk of failure nearly fourfold. Simply being female increased the odds of procedural failure by a factor of 2.04.
PCI failure also resulted in significantly higher rates of death during the initial hospitalization (17.8% vs. 3.2%; p<0.001) and over the following year (44.7% vs. 13.0%, p<0.001). After PCI failure, patients were also more likely to suffer another heart attack within a year (20.0% vs. 8.1%, p=0.05) and to need a repeat procedure to open the artery blocked during the heart attack (23.1% vs. 8.3%, p=0.02).
Dr. Ben-Dor and his colleagues are continuing to investigate why women are at a disadvantage in heart attack PCI. They are currently analyzing some 800 arterial x-rays, or angiograms, taken in men and women experiencing a heart attack. The angiograms will help determine whether the explanation lies in the location of the obstructing lesion, or in lesion characteristics such as calcification, length, the number of twists and turns in the obstructed artery, and the amount of the blood clot blocking the artery.
For the second study, researchers at Zhongshan Hospital in Shanghai analyzed data from 692 consecutive patients who had a STEMI heart attack and were treated with PCI. Of these, 142 were women and 550 were men. Overall, 63% of patients were considered elderly (older than 60 years), but the proportion was much higher in women than in men (88.5% vs.56.5%, p=0.000). The average age of female patients was 71.1 years, as compared to 62.4 years for men (p=0.000). Women were also more likely to be diabetic (26.6% vs.18.4%, p=0.03). Rates of multivessel disease were similar in the two groups, as was the specific location of the arterial blockage that caused the heart attack. Other features, however, made PCI more challenging in women.
"In clinical practice, older females have more three-vessel disease, more calcified or tortuous lesions, and the arteries are smaller," said Junbo Ge, MD, a professor of medicine at Fudan University; director of cardiology at Zhongshan Hospital; and co-chairman of the Shanghai Institute of Cardiovascular Diseases, all in Shanghai, China. "All of these characteristics create technical difficulties and challenges in performing PCI in women, easily causing more complications and suboptimal results."
Indeed, Dr. Ge and his colleagues found that PCI was less successful in restoring full blood flow through the treated artery in women than in men, as indicated by the average "TIMI" score (2.8 vs. 2.9, p=0.048). In addition, women required a longer hospital stay (14.5 days vs.12.4 days, on average, p=0.02). The rates of serious complications, such as stroke, major bleeding and repeat heart attack during the initial hospitalization were similar in the two groups, but the in-hospital death rate in women was significantly higher, 12.8% vs. 5.4% in men, p=0.003.
The investigators concluded the survival disadvantage among women might be explained by their older age and less desirable PCI results.
"We need a large prospective study to confirm these findings and to determine why the final TIMI flow through the coronary artery was worse in female patients," Dr. Ge said. "Also, we should use new therapies, PCI devices, and strategies to further improve survival in women."
Society for Cardiovascular Angiography and Interventions
Heart Attack Current Events and Heart Attack News RSSFeeling lonely adds to rate of blood pressure increase in people 50 years old and older
Chronic feelings of loneliness take a toll on blood pressure over time, causing a marked increase after four years, according to a new study at the University of Chicago.
Mount Sinai researchers are the first to identify heart abnormalities in World Trade Center workers
Researchers from Mount Sinai School of Medicine are presenting more than 20 ground-breaking studies at the American College of Cardiology (ACC) 59th annual scientific session (ACC.10) in Atlanta.
As Girth Grows, Risk of Sudden Cardiac Death Shrinks
Obesity has long been identified as a risk factor for cardiovascular disease and heart failure. But, a new study conducted by researchers at the University of Rochester Medical Center found that being skinny confers no advantage when it comes to the risk of dying suddenly from cardiac causes.
New guidelines aim to prevent unnecessary death from thoracic aortic disease
When actor John Ritter died suddenly in 2003 from a tear in his thoracic aorta-the large artery that carries blood from the heart to the rest of the body-that tragedy brought attention to a rare but deadly condition that takes the lives of an estimated 10,000 Americans each year.
ACCORD: Intensive BP, combined lipid therapies do not help adults with diabetes
Lowering blood pressure to normal levels - below currently recommended levels - did not significantly reduce the combined risk of fatal or nonfatal cardiovascular disease events in adults with type 2 diabetes who were at especially high risk for cardiovascular disease events, according to new results from the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial.
UF researcher urges caution in reducing blood pressure in patients with diabetes, coronary disease
For patients with diabetes and heart disease, less isn't always more - at least when it comes to blood pressure.
Was the recent US stock market drop accompanied by more heart attacks? Duke studies relationship
A novel report explores the possible relationship between fluctuations in the stock market and the incidence of local heart attacks. The results were presented at the annual scientific meeting of the American College of Cardiology by a team of researchers from Duke University Medical Center.
Device advances interventional radiology treatment to clear blocked carotid arteries, prevent stroke
An important interventional radiology advancement-the use of a new cerebral protection device in combination with FDA-approved carotid stents in high-surgical-risk patients-provides a minimally invasive, safe and effective way to prevent stroke from occurring during treatment to clear blocked carotid arteries.
Vitamin D levels have different effects on atherosclerosis in blacks and whites
Vitamin D is quickly becoming the "go-to" remedy for treating a wide range of illnesses, from osteoporosis to atherosclerosis. However, new evidence from a Wake Forest University School of Medicine study suggests that supplementing vitamin D in those with low levels may have different effects based on patient race and, in black individuals, the supplement could actually do harm.
New method to grow arteries could lead to 'biological bypass' for heart disease
A new method of growing arteries could lead to a "biological bypass"-or a non-invasive way to treat coronary artery disease, Yale School of Medicine researchers report with their colleagues in the April issue of Journal of Clinical Investigation.
More Heart Attack Current Events and Heart Attack News Articles
 |
The Cardiac Recovery Handbook: The Complete Guide to Life After Heart Attack or Heart Surgery, Second Edition by Paul Kligfield (Author) Maybe a suspicious angiogram has the doctor suggesting bypass surgery. Maybe a major heart attack has you confined to the ICU. After a heart attack or heart surgery, you have a hundred questions and your family has more. How long will I be in the hospital? What are the side effects of that medication? Why do I feel so depressed? What can I eat? Can I exercise? One of the nation's most respected cardiologists answers all your questions in The Cardiac Recovery Handbook. In clear, everyday language, the book covers all aspects of cardiac recovery—from the initial diagnosis of heart disease to medications and surgical options, from hospitalization to rehabilitation, from diet and exercise to keeping your spirits up. No question is left unanswered. Filled with a wealth of vital... |
 |
The Last War 1980-84 by Heart Attack |
 |
A Heart Attack Survivor's Guide to a Long Healthy Life by Nelson Anderson (Author) Written by a heart attack survivor who, 10 years after his attack, is now fitter and leaner than he's ever been, this book details a lifestyle change which will promote weight loss and bring energy and vitality. The author shares his daily diet plan, including supplements, an easy-to-follow exercise regime, and even a few healthful recipes for delicious low-carb meals and snacks. Fed up with a life of confusion and fear, the author transformed himself into a human guinea pig. After years of painstaking research and trial-and-error, he finally came to understand what works, what doesn't work -- and why. His goal is to share this knowledge and joy with fellow survivors, their loved ones, and anyone who fears a heart attack in the years ahead |
 |
Heart Attack Low vs Diamond (Primary Contributor) |
 |
The Cleveland Clinic Guide to Heart Attacks (Cleveland Clinic Guides) by Curtis Rimmerman (Author) Keep Your Heart Healthy and Preserve the Quality of Your Life! The statistics are staggering: More than 1 million people have new or recurrent heart attacks every year. Don’t become a statistic. Make the decision today to educate yourself about keeping your heart healthy. In The Cleveland Clinic Guide to Heart Attacks, Dr. Curtis Rimmerman, one of America’s foremost authorities on heart health, reveals important information for patients and their families on how to avoid a heart attack or survive and thrive after one. Inside you’ll find advice to help you: Understand the risk factors and minimize the likelihood of having a heart attack.· Discover the best possible methods for managing heart problems, using medical, surgical, interventional, and rehabilitative... |
 |
Sweet Dee Has A Heart Attack Also With: FOX (Producer) |
 |
Disciple Women's Heart Attack Snowboard Mitten, White, Medium by Disciple |
 |
HEART HEALTHY TIPS by The U.S. Heart Healthy Company Not sure where to start when it comes to improving your heart health? Take some time and create a plan that you can stick to. Include specific goals to eat healthier, exercise more regularly and have a medical physical if it’s been more than a year. |
 |
Sheer Heart Attack by Queen Japanese exclusive 2001 remastered reissue of 1974 album. |
 |
FlameEz-Vascular, 60 Capsules/Bottle by FlameEz Inflammation plays a key role in plaque building up in coronary arteries, which leads to heart disease and heart attack. At the early stage, the plaque can build up quickly in inflamed arteries. If inflammatory conditions persist, the plaque can expand rapidly causing blood vessel narrowing. In advanced stage, inflammation leads to development of "soft" plaque that can rupture suddenly and cause heart attack. For many, cardiovascular disease is a silent disease, with no visible signs or symptoms until it suddenly leads to a heart attack or stroke. It is widely accepted that control of inflammation may yield a more ‘stable’ plaque that less likely to rupture. However, there are currently no medications available for direct treatment of the underlying chronic inflammation associated... |
| © 2010 BrightSurf.com |