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

Anders Hvelplund; Søren Galatius; Mette Madsen; Rikke Sørensen; Jan Kyst Madsen; Allan Zeeberg Iversen; Hans-Henrik Tilsted; Steffen Helqvist; Poul Erik Mortensen; Per Hostrup Nielsen; Eva Prescott; Steen Zabell Abildstrøm

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

Anders Hvelplund, Søren Galatius, Mette Madsen, Rikke Sørensen, Jan Kyst Madsen, Allan Zeeberg Iversen, Hans-Henrik Tilsted, Steffen Helqvist, Poul Erik Mortensen, Per Hostrup Nielsen, Eva Prescott, Steen Zabell Abildstrøm

8 Citations (Scopus)

Abstract

Objective: To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI). Design: Observational cohort study. Setting: Nationwide registries. 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. 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. Main Outcome Measures: All-cause mortality and readmission with AMI. Initiation of secondary preventive medication. 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. 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.

Original language	English
Journal	Journal of Invasive Cardiology
Volume	24
Issue number	1
Pages (from-to)	19-24
Number of pages	6
ISSN	1042-3931
Publication status	Published - Jan 2012

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Hvelplund, A., Galatius, S., Madsen, M., Sørensen, R., Madsen, J. K., Iversen, A. Z., Tilsted, H-H., Helqvist, S., Mortensen, P. E., Nielsen, P. H., Prescott, E., & Abildstrøm, S. Z. (2012). 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. Journal of Invasive Cardiology, 24(1), 19-24. http://www.invasivecardiology.com/articles/significance-invasive-strategy-after-acute-myocardial-infarction-prognosis-and-secondary

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. / Hvelplund, Anders; Galatius, Søren; Madsen, Mette et al.

In: Journal of Invasive Cardiology, Vol. 24, No. 1, 01.2012, p. 19-24.

Research output: Contribution to journal › Journal article › Research › peer-review

Hvelplund, A, Galatius, S, Madsen, M, Sørensen, R, Madsen, JK, Iversen, AZ, Tilsted, H-H, Helqvist, S, Mortensen, PE, Nielsen, PH, Prescott, E & Abildstrøm, SZ 2012, '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', Journal of Invasive Cardiology, vol. 24, no. 1, pp. 19-24. <http://www.invasivecardiology.com/articles/significance-invasive-strategy-after-acute-myocardial-infarction-prognosis-and-secondary>

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title = "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",

abstract = "Objective: To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI). Design: Observational cohort study. Setting: Nationwide registries. 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. 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. Main Outcome Measures: All-cause mortality and readmission with AMI. Initiation of secondary preventive medication. 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. 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.",

author = "Anders Hvelplund and S{\o}ren Galatius and Mette Madsen and Rikke S{\o}rensen and Madsen, {Jan Kyst} and Iversen, {Allan Zeeberg} and Hans-Henrik Tilsted and Steffen Helqvist and Mortensen, {Poul Erik} and Nielsen, {Per Hostrup} and Eva Prescott and Abildstr{\o}m, {Steen Zabell}",

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language = "English",

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T1 - Significance of the invasive strategy after acute myocardial infarction on prognosis and secondary preventive medication

T2 - a nationwide study of 6364 women and 11,915 men

AU - Hvelplund, Anders

AU - Galatius, Søren

AU - Madsen, Mette

AU - Sørensen, Rikke

AU - Madsen, Jan Kyst

AU - Iversen, Allan Zeeberg

AU - Tilsted, Hans-Henrik

AU - Helqvist, Steffen

AU - Mortensen, Poul Erik

AU - Nielsen, Per Hostrup

AU - Prescott, Eva

AU - Abildstrøm, Steen Zabell

PY - 2012/1

Y1 - 2012/1

N2 - Objective: To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI). Design: Observational cohort study. Setting: Nationwide registries. 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. 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. Main Outcome Measures: All-cause mortality and readmission with AMI. Initiation of secondary preventive medication. 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. 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.

AB - Objective: To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI). Design: Observational cohort study. Setting: Nationwide registries. 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. 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. Main Outcome Measures: All-cause mortality and readmission with AMI. Initiation of secondary preventive medication. 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. 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.

M3 - Journal article

C2 - 22210585

SN - 1042-3931

VL - 24

SP - 19

EP - 24

JO - Journal of Invasive Cardiology

JF - Journal of Invasive Cardiology

IS - 1

ER -

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

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