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      Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después Translated title: Gender bias in women with myocardial infarction: ten years after

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          Abstract

          Objetivo. Estudios previos muestran que las mujeres con infarto agudo de miocardio (IAM) reciben menos fibrinólisis que los hombres. El objetivo de este trabajo es analizar si existen actualmente diferencias de tratamiento ligadas al género y comparar los resultados con los obtenidos hace 10 años. Diseño. Se trata de un estudio descriptivo retrospectivo que compara pacientes con IAM de los estudios Análisis de Retraso en Infarto Agudo de Miocardio (ARIAM) en 2003-2004 y Proyecto de Análisis Epidemiológico de Paciente Crítico (PAEEC) de 1992-1993. Ámbito. Servicios de Medicina Intensiva de 86 hospitales en el PAEEC y 120 en el ARIAM. Pacientes. Nueve mil novecientos ochenta y uno incluidos en el ARIAM y 1.668 en el PAEEC. Resultados. Las mujeres tienen menos probabilidad de recibir fibrinólisis que los hombres (odds ratio= 0,82, p < 0,01), independientemente de su edad, antecedentes, procedencia o tamaño del hospital. La probabilidad de fibrinólisis es asimismo menor en ancianos, pacientes procedentes de planta, hospitales de más de mil camas, enfermos con hipertensión arterial, accidente cerebrovascular, diabetes o enfermedad vascular periférica. La probabilidad es mayor en trasladados desde otro hospital (seguidos por los de Urgencias), en hospitales de menos de 300 camas (seguidos por los de 300-1.000) y si hay historia de cardiopatía isquémica. Comparando los dos periodos, ha aumentado la frecuencia de fibrinólisis en ambos géneros, aunque el incremento ha sido mayor en mujeres. Conclusiones. Las mujeres con IAM continúan recibiendo menos fibrinólisis, aunque existe un aumento en el número de tratamientos, superior al registrado en los hombres.

          Translated abstract

          Objective. Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. Design. Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. Setting. ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. Patients. We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. Results. Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. Conclusions. The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

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          Treatment of acute myocardial infarction and 30-day mortality among women and men.

          Previous studies have suggested that women with acute myocardial infarction receive less aggressive therapy than men. We used data from the Cooperative Cardiovascular Project to determine whether women and men who were ideal candidates for therapy after acute myocardial infarction were treated differently. Information was abstracted from the charts of 138,956 Medicare beneficiaries (49 percent of them women) who had an acute myocardial infarction in 1994 or 1995. Multivariate analysis was used to assess differences between women and men in the medications administered, the procedures used, the assignment of do-not-resuscitate status, and 30-day mortality. Among ideal candidates for therapy, women in all age groups were less likely to undergo diagnostic catheterization than men. The difference was especially pronounced among older women; for a woman 85 years of age or older, the adjusted relative risk was 0.75 (95 percent confidence interval, 0.68 to 0.83). Women were somewhat less likely than men to receive thrombolytic therapy within 60 minutes (adjusted relative risk, 0.93; 95 percent confidence interval, 0.90 to 0.96) or to receive aspirin within 24 hours after arrival at the hospital (adjusted relative risk, 0.96; 95 percent confidence interval, 0.95 to 0.97), but they were equally likely to receive beta-blockers (adjusted relative risk, 0.99; 95 percent confidence interval, 0.95 to 1.03) and somewhat more likely to receive angiotensin-converting-enzyme inhibitors (adjusted relative risk, 1.05; 95 percent confidence interval, 1.02 to 1.08). Women were more likely than men to have a do-not-resuscitate order in their records (adjusted relative risk, 1.26; 95 percent confidence interval, 1.22 to 1.29). After adjustment, women and men had similar 30-day mortality rates (hazard ratio, 1.02; 95 percent confidence interval, 0.99 to 1.04). As compared with men, women receive somewhat less aggressive treatment during the early management of acute myocardial infarction. However, many of these differences are small, and there is no apparent effect on early mortality.
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            Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1,000 patients

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              Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry).

              There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-adjusted OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart failure more often during their hospital stay. The age-adjusted long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women.
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                Author and article information

                Contributors
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                Journal
                medinte
                Medicina Intensiva
                Med. Intensiva
                Elsevier España, S.L. (, , Spain )
                0210-5691
                October 2008
                : 32
                : 7
                : 329-336
                Affiliations
                [02] Sagunto Valencia orgnameHospital de Sagunto orgdiv1Servicio de Medicina Preventiva España
                [04] Málaga orgnameHospital Carlos Haya España
                [01] orgnameHospital de Sagunto orgdiv1Servicio de Medicina Intensiva
                [03] Elche orgnameHospital de Elche orgdiv1Servicio de Medicina Intensiva España
                Article
                S0210-56912008000700002
                10.1016/S0210-5691(08)76210-7
                6c392328-7aef-4bdb-b00f-3c803a6648b6

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 55, Pages: 8
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                SciELO Spain


                diferencia de género,fibrinólisis,infarto agudo de miocardio,gender bias,fibrynolisis,acute myocardial infarction

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