@article{a7ac98b1aa4542f1bd993abbfa08c839,
title = "Contemporary Sex-Based Differences by Age in Presenting Characteristics, Use of an Early Invasive Strategy, and Inhospital Mortality in Patients with Non-ST-Segment-Elevation Myocardial Infarction in the United States",
abstract = "Background - Prior studies have reported higher inhospital mortality in women versus men with non-ST-segment-elevation myocardial infarction. Whether this is because of worse baseline risk profile compared with men or sex-based disparities in treatment is not completely understood. Methods and Results - We queried the 2003 to 2014 National Inpatient Sample databases to identify all hospitalizations in patients aged ≥18 years with the principal diagnosis of non-ST-segment-elevation myocardial infarction. Complex samples multivariable logistic regression models were used to examine sex differences in use of an early invasive strategy and inhospital mortality. Of 4 765 739 patients with non-ST-segment-elevation myocardial infarction, 2 026 285 (42.5%) were women. Women were on average 6 years older than men and had a higher comorbidity burden. Women were less likely to be treated with an early invasive strategy (29.4% versus 39.2%; adjusted odds ratio, 0.92; 95% confidence interval, 0.91-0.94). Women had higher crude inhospital mortality than men (4.7% versus 3.9%; unadjusted odds ratio, 1.22; 95% confidence interval, 1.20-1.25). After adjustment for age (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) and additionally for comorbidities, other demographics, and hospital characteristics, women had 10% lower odds of inhospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.89-0.92). Further adjustment for differences in the use of an early invasive strategy did not change the association between female sex and lower risk-adjusted inhospital mortality. Conclusions - Although women were less likely to be treated with an early invasive strategy compared with men, the lower use of an early invasive strategy was not responsible for the higher crude inhospital mortality in women, which could be entirely explained by older age and higher comorbidity burden.",
keywords = "comorbidity, hospital mortality, hospitalization, length of stay, risk factors",
author = "Tanush Gupta and Dhaval Kolte and Sahil Khera and Nayan Agarwal and Villablanca, {Pedro A.} and Kashish Goel and Kavisha Patel and Aronow, {Wilbert S.} and Jose Wiley and Bortnick, {Anna E.} and Aronow, {Herbert D.} and Abbott, {J. Dawn} and Pyo, {Robert T.} and Panza, {Julio A.} and Menegus, {Mark A.} and Rihal, {Charanjit S.} and Fonarow, {Gregg C.} and Garcia, {Mario J.} and Bhatt, {Deepak L.}",
note = "Funding Information: Dr Bortnick reports funding from the Empire Clinical Research Investigator Program and National Institutes of Health/National Center for Advancing Translational Science Einstein-Montefiore CTSA Grant Number UL1TR001073, and AHA Mentored Clinical and Population Award. Dr Bhatt discloses the following relationships in advisory board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; honoraria: American College of Cardiology (senior associate editor, clinical trials and news, ACC.org), Belvoir publications (editor in chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (editor in chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (chief medical editor, Cardiology Today{\textquoteright}s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (deputy editor), NCDR-ACTION Registry Steering Committee (chair), VA CART Research and Publications Committee (chair); research funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; royalties: Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald{\textquoteright}s Heart Disease); site coinvestigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); trustee: American College of Cardiology; unfunded research: FlowCo, Merck, PLx Pharma, Takeda. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2018 American Heart Association, Inc.",
year = "2018",
month = jan,
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.117.005735",
language = "English (US)",
volume = "11",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}