Female myocardial infarction
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Female Myocardial Infarction: Diagnosis, Experiences, and Outcomes
High-Sensitivity Cardiac Troponin in Women
Optimizing Diagnosis with Female-Specific Thresholds
Research indicates that high-sensitivity cardiac troponin (hs-cTn) levels are generally lower in women compared to men. However, clinical practice often uses a single threshold for diagnosing myocardial infarction (MI) based on the 99th percentile of the overall population. The CODE-MI trial aims to determine if using a lower, female-specific hs-cTn threshold can improve diagnosis, treatment, and outcomes for women presenting with symptoms of myocardial ischemia. This trial involves multiple hospitals and will compare outcomes before and after implementing these female-specific thresholds.
Women's Experiences During Myocardial Infarction
Symptom Recognition and Response
A systematic review and meta-ethnography have identified that women often do not perceive their MI symptoms as severe or life-threatening, leading to delays in seeking medical help. The review highlighted three main themes: feeling changes in the body, understanding these changes, and acting on them. Women who did recognize their symptoms as severe sought help more promptly. This delay in response can significantly impact outcomes and underscores the need for better education and awareness among women regarding MI symptoms.
Outcomes in Young Women with Myocardial Infarction
Worse Prognosis Compared to Men
Studies show that young women (≤50 years) who experience their first MI have worse outcomes compared to men. Women are less likely to undergo invasive procedures like coronary angiography and revascularization and are less frequently prescribed guideline-directed medical therapies. Despite similar in-hospital mortality rates, women have higher all-cause mortality post-discharge. This disparity highlights the need for improved treatment protocols and follow-up care for young women with MI.
Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)
Prevalence and Prognosis
MINOCA, which occurs in up to 15% of all acute MIs, disproportionately affects women. Despite having fewer traditional cardiovascular risk factors, MINOCA patients have a prognosis similar to those with obstructive coronary artery disease. The condition involves a variety of mechanisms, including coronary vasospasm, microvascular dysfunction, and spontaneous coronary artery dissection (SCAD). Accurate diagnosis often requires advanced imaging techniques to identify the underlying cause and guide treatment .
Gender Disparities in STEMI Care
In-Hospital Care and Outcomes
A global meta-analysis of patients with ST-segment elevation myocardial infarction (STEMI) revealed significant gender disparities in care and outcomes. Women are older at presentation, have more comorbidities, and receive less timely and aggressive treatment compared to men. These factors contribute to higher in-hospital mortality, repeat MI, stroke, and major bleeding rates in women. Addressing these disparities requires targeted interventions to ensure timely and appropriate care for female STEMI patients.
Coping and Social Support Post-Myocardial Infarction
Gender Differences in Recovery
Women and men differ in their coping strategies and perceptions of social support following an MI. Women often use more coping strategies but report less social support and information about their condition and rehabilitation. They also experience a lack of belief in their heart problems from caregivers. Men, on the other hand, tend to involve their spouses more in their recovery and receive more support. These differences suggest that healthcare providers need to be more sensitive to gender-specific needs and provide tailored support to improve recovery outcomes for women.
Conclusion
The research highlights significant gender differences in the diagnosis, experiences, and outcomes of myocardial infarction. Women often face delays in diagnosis and treatment, receive less aggressive care, and have worse long-term outcomes compared to men. Addressing these disparities requires a multifaceted approach, including the use of female-specific diagnostic thresholds, better education and awareness of MI symptoms among women, and more tailored support and treatment protocols. By understanding and addressing these gender-specific issues, healthcare providers can improve the prognosis and quality of life for women experiencing myocardial infarction.
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