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THE INFLUENCE OF SEX FOR THE NEXT FORECASTS AND EFFECTIVENESS OF THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-SEGMENT ELEVATION

Authors: Netyazhenko N.V.

Pages: 326-332

Abstract


The aim to study and compare the results of pharmacological reperfusion and its influence on the course of acute coronary syndrome (ACS) in both sexes.

Materials and Methods

The study included 73 patients of comparable age, comorbidities, a history and treatment assigned and distributed the following groups: group I (n = 14 men, n = 14 women) - patients who conducted thrombolytic therapy to 4 hours from the beginning of symptoms and the group II (n = 20 males, n = 20 women) - patients who conducted thrombolytic therapy in term> 4 <6 hours from the start of the first symptom. After thrombolytic therapy for hospital period it was evaluated in patients develop fatal and non-fatal cardiovascular events: recurrence of pain, acute left ventricular failure (ALVF) class II-V by Killip, arrhythmias and conduction recurrence of MI, hemorrhage, mortality. The development of these events in patients regarded as a manifestation of adverse flow.

Results

Thrombolytic therapy (TLT) <4 hours of the first symptoms accompanied by an increased risk of bleeding is 5 times among women compared with men. Among men in the group of early TLT lethal consequence developed in 4 (22.6%), while among women had no place (all p <0.05). Gender differences were detected in the remote TLT group (> 4 <6 hours). Among women group I (TLT (<4 hours) compared with women group II (TLT> 4 <6 hours) was noted increase in the frequency of re-MI (p <0.05) and mortality (p <0,01).

Conclusions

1. Implementation of TLT in up to 4 hours of onset of symptoms of ACS with ST-segment elevation is associated with increased risk of bleeding is 5 times among women compared with men (p <0.05). Death among men was significantly higher than in women whith early pharmacological reperfusion (<4 hours), and occurred in 28.6% (p <0.05).

2. The risk of complications such as MI recurrence (p <0.05) and mortality (p <0,01) increased with time from onset of symptoms to start of thrombolysis only among women.
3. The effectiveness of thrombolysis among women and men with early (<4 hours) and remote thrombolytic therapy (> 4 <6 hours) were not significantly different.

Keywords: women, reperfusion, thrombolysis, myocardial infarction.

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References

  1. Casella G., Ottani F., Ortolani P., Guastaroba P., Santarelli A., Balducelli M., Marzocchi A.. Off-hour primary percutaneous coronary angioplasty does not affect outcome of patients with ST-Segment elevation acute myocardial infarction treated within a regional network for reperfusion: the REAL (Registro Regionale Angioplastiche dell'Emilia-Romagna) registry.JACC: Cardiovascular Interventions. 2011;4: 270-278.
  2. Gershlick A.H., Banning A.P., Myat A., Verheugt F.W., Gersh B. J. Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention?.The Lancet. 2013;382(9892): 624-632.
  3. Go A.S., Mozaffarian D., Roger V.L., Benjamin E.J., Berry J.D., Borden W.B., Turner M.B.. Executive summary: heart disease and stroke statistics: 2013 update: a report from the American Heart Association.Circulation. 2013; 127(1):143-146
  4. Isorni M., Blanchard D., Teixeira N., le Breton H., Renault N., Gilard M., Puymirat E.  Impact of gender on use of revascularization in acute coronary syndromes: The national observational study of diagnostic and interventional cardiac catheterization (ONACI).Catheterization and Cardiovascular Interventions
  5. Jackson E.A., Moscucci M., Smith D.E., Share D., Dixon S., Greenbaum A., Gurm H.S. The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).American heart journal. 2011;161(1):106-112.
  6. Johnston N, Bornefalk-Hermansson A, Schenck-Gustafsson K, Held C, Goodman SG, Yan AT, Bierman AS. Do clinical factors explain persistent sex disparities in the use of acute reperfusion therapy in STEMI in Sweden and Canada? Eur Heart J Acute Cardiovasc Care. 2013;2:350–358. doi:
  7. Peterson E.D., Lansky A.J., Kramer J., Anstrom K., Lanzilotta M.J., National Cardiovascular Network Clinical Investigators. Effect of gender on the outcomes of contemporary percutaneous coronary intervention.The American journal of cardiology. 2001;88(4), 359-364.
  8. Steg P.G., James S.K., Atar D., Badano L.P., Blömstrom-Lundqvist C., Borger M.A.  Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J. 2012;33(20): 2569-2619.
  9. Van de Werf F., Ardissino D., Betriu A., Cokkinos D.V., Falk E., Fox K. A., Wijns W. Management of acute myocardial infarction in patients presenting with ST-segment elevation.European heart journal. 2008; 24(1): 28-66.