title: Gender differences in presentation, management and inhospital outcome in patients with ST-segment elevation myocardial infarction: data from 5000 patients included in the ORBI prospective French regional registry.
abstract: BACKGROUND
  Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported.
  
  
  OBJECTIVE
  To determine whether female gender is associated with higher inhospital mortality.
  
  
  METHODS
  Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men).
  
  
  RESULTS
  The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; P<0.05). Reperfusion strategies in women less frequently involved fibrinolysis, coronary angiography, radial access and thrombo-aspiration. Female gender, especially in patients aged<60 years, was associated with poorer inhospital prognosis (including higher inhospital mortality: 9% vs. 4% in men; P<0.0001), and underutilization of recommended treatments at discharge. Moreover, excess female inhospital mortality was independent of presentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04).
  
  
  CONCLUSIONS
  One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality.
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France. Electronic address: guillaume.leurent@chu-rennes.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leurent
authors.affiliation: École des Hautes Études en Santé Publique, Rennes, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Garlantézec
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.affiliation: Centre Hospitalier de Lorient, Service de Cardiologie, Lorient, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Hacot
authors.affiliation: CHU de Rennes, SAMU, Rennes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Coudert
authors.affiliation: Centre Hospitalier de Vannes, Service de Cardiologie, Vannes, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Filippi
authors.affiliation: Centre Hospitalier de Saint-Malo, Service de Cardiologie, Saint-Malo, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rialan
authors.affiliation: Centre Hospitalier de Saint-Brieuc, Service de Cardiologie, Saint-Brieuc, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Moquet
authors.affiliation: Centre Hospitalier de Quimper, Service de Cardiologie, Quimper, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rouault
authors.affiliation: CHU de Brest, Service de Cardiologie, Brest, France; EA 4324 - Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: CHU de Brest, Service de Cardiologie, Brest, France; EA 4324 - Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Castellant
authors.affiliation: Clinique Saint-Laurent, Service de Cardiologie, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Druelles
authors.affiliation: Centre Hospitalier de Vannes, SAMU, Vannes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Boulanger
authors.affiliation: CHU de Brest, SAMU, Brest, France.
authors.forename: Josiane
authors.initials: J
authors.lastname: Treuil
authors.affiliation: Centre Hospitalier de Saint-Brieuc, SAMU, Saint-Brieuc, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Avez
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Marielle
authors.initials: M
authors.lastname: Le Guellec
authors.affiliation: Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000359:Aftercare / Q000379:methods / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D019468:Disease Management; D004630:Emergencies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012727:Sex Characteristics; D063507:Sexism; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Differences; Différences; Gender; Genre; Mortality; Mortalité; Outcome; Pronostic; ST-segment elevation myocardial infarction; Syndrome coronaire aigu avec sus-décalage persistant du segment ST