Clinical, echocardiographic and angiographic correlation of acute coronary syndrome in women at a tertiary care centre

Authors

  • Chetana Krishnegowda Department of Medicine, KIMS, Hubli, Karnataka
  • Mallikarjuna H. Swamy Department of Medicine, KIMS, Hubli, Karnataka

DOI:

https://doi.org/10.18203/2320-6012.ijrms20161932

Keywords:

Coronary artery disease, Diabetes mellitus, Gender-specific, HsCRP, Myocardial infarction, Women

Abstract

Background: The evaluation of coronary artery disease (CAD) in women presents a unique and difficult challenge for clinicians, owing to the differences in symptoms, clinical features and mortality as compared to men. This study is to analyze the risk factors, clinical presentation, complications and outcome in women who presented with myocardial infarction.

Methods: The study was conducted among women admitted with acute myocardial infarction in coronary care unit of KIMS Hospital, Hubli from January 2013 to December 2013. After inclusion and exclusion criteria 100 women underwent detailed history, clinical examination and investigations.

Results: The mean age of the study group was 57.98 years. 49% of patients presented with atypical symptoms with majority being postmenopausal (87%). HDL cholesterol was the commonest risk factor followed by HsCRP, increased waist circumference and diabetes mellitus, with the least common risk factor being elevated homocysteine. Pump failure was the commonest complication. Double vessel disease was more common in diabetic population whereas single disease was common in non-diabetic population.

Conclusions: Women clinically present with atypical symptoms that resulted in significant delay to reach hospital. Novel risk factors like HsCRP and homocysteine may improve risk detection in women with CAD. Identifying and targetting lifestyle risk factors. Diabetes mellitus in particular is the key to reduction in CAD in women.

 

References

Merz CN, Shaw LJ. Stable angina in women: lessons from the National Heart, Lung and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation. J CardiovascMed. 2011;12(2):85-7.

Lerman A, Sopko G.Women and cardiovascular heart disease: clinical implications from the Women’s Ischemia Syndrome Evaluation (WISE) study: are we smarter? J Am CollCardiol. 2006;47(3):S59-62.

Anand SS, Islam S, Rosengren A, Franzosi MG, Steyn K, Yusufali AH, et al. Risk factors for myocardial infarction in women and men: insights from the inter heart study. EurHeart J. 2008;29(7):932-40.

Neill J, Adgey J. Predictors of excess mortality after myocardial infarction in women. Ulster Med J. 2008;77(2):89-96.

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al, for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2-220.

Thom TJ, Kannel WB, Silbershatz H, D’Agostino RB Sr. Cardiovascular diseases in the United States and prevention approaches. In: Fuster V, Alexander RW, O’Rourke RA, Roberts R, Spencer BK III, Weller JJ, eds. Hurst’s the Heart. 10 ed. New York, NY: McGraw-Hill; 2001;3-18.

Gupta VK, Arora P, Kumar R. Evaluation of right ventricular involvement in inferior wall infarction. J Assoc Phys India. 1985;33.

Jenkins JS, Flaker GC, Nolte B, Price LA, Morris D, Kurz J. et al. Causes of higher in hospital mortality in women than men after acute myocardial infarction. Am J Cardiol. 1994;73:319-22.

Howard D, Gilpin E, Nicod P, Cal G, Henning H, Ross J. Acute myocardial infarction in women: Influence of gender on mortality and prognostic variables. Am J Cardiol. 1988;62:17.

Bhat AR, Sing D. Study of acute myocardial infarction in women. .J AssocPhysc India 1991;39:67.

Charles L. Treatment and outcome of acute myocardial infarction in women 75 years and older. Cardiology in elderly. 1993;1:121-25.

Culic V, Eterovic D, Miric D, Sillic D. Symptom presentation of acute myocardial infarction: Influence of sex, age and risk factors. Am Heart J. 2002:144:1012-17.

Thuresson M, Jarlöv MB, Lindahl B, Svensson L, Zedigh C, Herlitz J. Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age and a history of diabetes. Am Heart J. 2005;150(2):234-42.

Sandra C, Beaver S, Peter M, Richard D, Herschel W, Eighton C. Treatment of acute myocardial infarction and 30-day mortality among women and men. NEJM. 2000;343:8-15.

Gurwitz JH, McLaughlin TJ, Willison DJ, Guadagnoli E, Hauptman PJ, et al. Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med. 1997;126(8):593-9.

Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, et al, for the Get With the Guidelines Steering Committee and Investigators. Sex differences in medical care and early death after acute myocardial infarction. Circulation. 2008;118:2803-10.

Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, et al, for the CRUSADE Investigators. Gender disparities in the diagnosis and treatment of nonST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol. 2005;45:832–7.

Alexander KP, Chen AY, Newby LK, Schwartz JB, Redberg RF, Hochman JS, et al, for the CRUSADE Investigators. Sex differences in major bleeding with glycoprotein IIb/III inhibitors: results from the CRUSADEinitiative. Circulation. 2006;114:1380-7.

Lloyd-Jones DM1, Leip EP, Larson MG, D'Agostino RB, Beiser A, Wilson PW, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 2006;113(6):7918.

Yavagal ST, Rangarajan R, Prabavathi, Chinnaiah D. Clinical profile of myocardial infarction in Indian women(Abstr). Indian Heart J. 1988;40:359.

Chatterjee SS, Bannerji A, Dutta S, Guha S, Mazumder B, Sanyal R, et al. Risk factors of myocardial infarction in Indian women. Indian Heart J. 1987;32:57.

Stone GW, Grines CL, Browne KF, Marco J, Rothumbaum D, O'Keefe J. et al. Comparison of in-hospital outcome in men versus women treated by either thrombolytic therapy or primary angioplasty for acute myocardial infarction. Am J Cardiol. 1995; 759:87-92.

Babu BR, RaoJv, Subramanyam G. Coronary heart disease in women- With special reference to young women. J AssocPhys India. 1984;32:48.

Dave TH, Wasir HS. Profile of coronary artery disease in women; Correlation of clinical, non-invasive and coronary angiographic findings. Indian Heart J. 1991;43(1):25-9.

Allen P. Burke, Andrew Farb, Gray T. Malcom, You-hui Liang. Effect of Risk Factors on the Mechanism of Acute Thrombosis and Sudden coronary death in women. Circulation. 1998;97;2110-6.

Farb A, Tang AL, Burke AP, Sessums L, Liang Y, Virmani R. Sudden coronary death: frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation. 1995;92:1701-9.

Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ. 2006;332:73-8.

Centers for Disease Control and Prevention. Health, United States, 2009: With Special Feature on Medical Technology. 2010.

Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557-62.

Bhat AR, Sing D. Study of acute myocardial infarction in women. J Assoc Physc India. 1991;39:67.

Howard D, Gilpin E, Nicod P, Cal G, Henning H, Ross J. Acute myocardial infarction in women: Influence of gender on mortality and prognostic variables. Am J Cardiol. 1988;62:17.

Hochman JS, Tamis JE, Thompson TD. Sex, clinical presentation and outcome in patients with acute coronary syndromes.N Engl J Med. 1999;341:226- 32.

Lee WL, Angela M. Cheung, Cape D, Zinman .B Impact of Diabetes on Coronary Artery Disease in Women and Men. Diabetes Care. 2000;23:962-8.

Kalin MF, Zumoff B. Sex hormones and coronary disease: a review of the clinical studies. Steroids. 1990;55:330-52.

Wingard DL, Barrett-Connor E. Heart disease and diabetes. In Diabetes in America, 2nd ed. Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 1995; 429–448 (NIH publ. no. 95-1468).

Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham Study. Diabetes Care. 1979;2:120-6.

Pan W, Cedres LB, Liu K, Dyer A, Schoenberger JA, Shekelle RB, et al. Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol. 1986;123:504-16.

Kleinman JC, Donahue RP, Harris MI, Finucane FF, Madans JH, Brock DB. Mortality among diabetics in a national sample. Am J Epidemiol. 1988;128:389-401.

Folsom AR, Szklo M, Stevens J, Liao F, Smith R, Eckfeldt JH. A prospective study of coronary heart disease in relation to fasting insulin, glucose, and diabetes: the Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 1997;20:935-42.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Inter-heart Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case-controlstudy. Lancet. 2004;364:937-52.

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Published

2017-01-03

How to Cite

Krishnegowda, C., & Swamy, M. H. (2017). Clinical, echocardiographic and angiographic correlation of acute coronary syndrome in women at a tertiary care centre. International Journal of Research in Medical Sciences, 4(7), 2684–2691. https://doi.org/10.18203/2320-6012.ijrms20161932

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Original Research Articles