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ST-Segment Elevation Myocardial Infarction: Sex Differences in Incidence, Etiology, Treatment, and Outcomes

  • Interventional Cardiology (SR Bailey and T Helmy, Section Editors)
  • Published:
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Abstract

Purpose

Although there have been marked improvements in the standard of care for treatment of ST-elevation myocardial infarction, women, especially younger women, continue to have significantly worse outcomes than men.

Recent Findings

This review highlights the current sex differences in presentation, etiology, treatment, and outcomes among these patients in order to make providers aware of the heterogeneous entities that cause ST-elevation myocardial infarction particularly in women and of disparities in treatment that lead to poorer outcomes in women.

Summary

Furthermore, it emphasizes evidence-based strategies including standardized protocols for early revascularization, mechanical circulatory support, and access methodology that can reduce sex-based disparities in treatments and outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang N-Y, Tsao CW and null n. Heart Disease and Stroke Statistics—2021 Update. Circulation. 2021;143:e254–e743.

  2. • Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P and Group ESCSD. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017;2018(39):119–77. These are the most up to date European guidelines for the treatment of STEMI.

    Google Scholar 

  3. • Lawton Jennifer S, Tamis-Holland Jacqueline E, Bangalore S, Bates Eric R, Beckie Theresa M, Bischoff James M, Bittl John A, Cohen Mauricio G, DiMaio JM, Don Creighton W, Fremes Stephen E, Gaudino Mario F, Goldberger Zachary D, Grant Michael C, Jaswal Jang B, Kurlansky Paul A, Mehran R, Metkus Thomas S, Nnacheta Lorraine C, Rao Sunil V, Sellke Frank W, Sharma G, Yong Celina M and Zwischenberger Brittany A. ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. J Am Col Cardio. 2021;0. These are the most up to date guidelines in the United States on the treatment of STEMI.

  4. Tern PJW, Ho AKH, Sultana R, Ahn Y, Almahmeed W, Brieger D, Chew DP, Fong AYY, Hwang J, Kim Y, Komuro I, Maemura K, Mohd-Ali R, Quek DKL, Reid C, Tan JWC, Wan-Ahmad WA, Yasuda S, Yeo KK. Comparative overview of ST-elevation myocardial infarction epidemiology, demographics, management, and outcomes in five Asia-Pacific countries: a meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2021;7:6–17.

    Article  PubMed  Google Scholar 

  5. • Shah T, Haimi I, Yang Y, Gaston S, Taoutel R, Mehta S, Lee HJ, Zambahari R, Baumbach A, Henry TD, Grines CL, Lansky A, Tirziu D. Meta-Analysis of Gender Disparities in in-hospital care and outcomes in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2021;147:23–32. This study summarizes the current literature on sex differences in presentation, comorbidities, delays to care, treatments, and outcomes for STEMI patients.

    Article  CAS  PubMed  Google Scholar 

  6. Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G, Kalpak O, Ricci B, Milicic D, Manfrini O, van der Schaar M, Badimon L, Bugiardini R. Sex differences in outcomes after STEMI: effect modification by treatment strategy and age. JAMA Intern Med. 2018;178:632–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stehli J, Martin C, Brennan A, Dinh DT, Lefkovits J and Zaman S. Sex differences persist in time to presentation, revascularization, and mortality in myocardial infarction treated with percutaneous coronary intervention. J Am Heart Asso. 2019;8:e012161.

  8. Shehab A, Bhagavathula AS, Alhabib KF, Ullah A, Suwaidi JA, Almahmeed W, AlFaleh H and Zubaid M. Age-related sex differences in clinical presentation, management, and outcomes in ST-segment–elevation myocardial infarction: pooled analysis of 15 532 patients from 7 Arabian Gulf Registries. J Am Heart Asso. 2020;9:e013880.

  9. Alkhouli M, Alqahtani F, Jneid H, Al Hajji M, Boubas W, Lerman A. Age-stratified sex-related differences in the incidence, management, and outcomes of acute myocardial infarction. Mayo Clin Proc. 2021;96:332–41.

    Article  PubMed  Google Scholar 

  10. Mefford MT, Li BH, Qian L, Reading SR, Harrison TN, Scott RD, Cavendish JJ, Jacobsen SJ, Kanter MH, Woodward M, Reynolds K. Sex-specific trends in acute myocardial infarction within an integrated healthcare network, 2000 Through 2014. Circulation. 2020;141:509–19.

    Article  PubMed  Google Scholar 

  11. • Khera S, Kolte D, Gupta T, Subramanian KS, Khanna N, Aronow WS, Ahn C, Timmermans RJ, Cooper HA, Fonarow GC, Frishman WH, Panza JA, Bhatt DL. Temporal trends and sex differences in revascularization and outcomes of ST-segment elevation myocardial infarction in younger adults in the United States. J Am Coll Cardiol. 2015;66:1961–72. This study examines sex differences in yoounger patients with STEMI, an understudied population.

    Article  PubMed  Google Scholar 

  12. • Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK, American Heart Association Cardiovascular Disease in W, Special Populations Committee of the Council on Clinical Cardiology CoE, Prevention CoC, Stroke N, Council on Quality of C and Outcomes R. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 2016;133:916–47. This consensus staements goes into detail on the multitude of sex differences in the patholophysiology in myocardial infarction in women and areas that continue to need further study.

  13. D’Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, Spertus JA, Krumholz HM. Sex differences in reperfusion in young patients with ST-segment–elevation myocardial infarction. Circulation. 2015;131:1324–32.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bucholz EM, Strait KM, Dreyer RP, Lindau ST, D’Onofrio G, Geda M, Spatz ES, Beltrame JF, Lichtman JH, Lorenze NP, Bueno H, Krumholz HM. Editor’s Choice-Sex differences in young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardiovasc Care. 2017;6:610–22.

    Article  PubMed  Google Scholar 

  15. Manfrini O, Yoon J, van der Schaar M, Kedev S, Vavlukis M, Stankovic G, Scarpone M, Miličić D, Vasiljevic Z, Badimon L, Cenko E and Bugiardini R. Sex differences in modifiable risk factors and severity of coronary artery disease. J Am Heart Asso. 2020;9:e017235.

  16. Geisler J, Omsjø IH, Helle SI, Ekse D, Silsand T, Lønning PE. Plasma oestrogen fractions in postmenopausal women receiving hormone replacement therapy: influence of route of administration and cigarette smoking. J Endocrinol. 1999;162:265–70.

    Article  CAS  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kalyani RR, Lazo M, Ouyang P, Turkbey E, Chevalier K, Brancati F, Becker D, Vaidya D. Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-aged adults. Diabetes Care. 2014;37:830–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, Wells Q, Bozkurt B, Labresh KA, Liang L, Hong Y, Newby LK, Fletcher G, Peterson E, Wexler L. Get With the Guidelines Steering C and Investigators. Sex differences in medical care and early death after acute myocardial infarction. Circulation. 2008;118:2803–10.

  20. Sederholm Lawesson S, Isaksson R-M, Ericsson M, Ängerud K and Thylén I. Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study. BMJ Open. 2018;8:e020211.

  21. Lichtman JH, Leifheit EC, Safdar B, Bao H, Krumholz HM, Lorenze NP, Daneshvar M, Spertus JA, D’Onofrio G. Sex differences in the presentation and perception of symptoms among young patients with myocardial infarction: evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation. 2018;137:781–90.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jia H, Abtahian F, Aguirre AD, Lee S, Chia S, Lowe H, Kato K, Yonetsu T, Vergallo R, Hu S, Tian J, Lee H, Park SJ, Jang YS, Raffel OC, Mizuno K, Uemura S, Itoh T, Kakuta T, Choi SY, Dauerman HL, Prasad A, Toma C, McNulty I, Zhang S, Yu B, Fuster V, Narula J, Virmani R, Jang IK. In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol. 2013;62:1748–58.

    Article  PubMed  Google Scholar 

  23. Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013;34:719–28.

    Article  CAS  PubMed  Google Scholar 

  24. Fahed AC, Jang I-K. Plaque erosion and acute coronary syndromes: phenotype, molecular characteristics and future directions. Nat Rev Cardiol. 2021;18:724–34.

    Article  PubMed  Google Scholar 

  25. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death. Arterioscler Thromb Vasc Biol. 2000;20:1262–75.

    Article  CAS  PubMed  Google Scholar 

  26. Yamamoto E, Yonetsu T, Kakuta T, Soeda T, Saito Y, Yan BP, Kurihara O, Takano M, Niccoli G, Higuma T, Kimura S, Minami Y, Ako J, Adriaenssens T, Boeder NF, Nef HM, Fracassi F, Sugiyama T, Lee H, Crea F, Kimura T, Fujimoto JG, Fuster V and Jang IK. Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes. J Am Heart Asso. 2019;8:e012322.

  27. Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Higuma T, Kimura S, Takano M, Yan BP, Adriaenssens T, Boeder NF, Nef HM, Kim CJ, McNulty I, Crea F, Kakuta T and Jang IK. Age and phenotype of patients with plaque erosion. J Am Heart Assoc. 2021;10:e020691.

  28. Kim HO, Kim CJ, Kim W, Cho JM, Soeda T, Takano M, Yan BP, Crea F, Niccoli G, Vergallo R, Minami Y, Higuma T, Kimura S, Boeder NF, Nef H, Adriaenssens T, Kurihara O, Thondapu V, Russo M, Yamamoto E, Sugiyama T, Lee H, Kakuta T, Yonetsu T, Jang IK. Relative risk of plaque erosion among different age and sex groups in patients with acute coronary syndrome. J Thromb Thrombolysis. 2020;49:352–9.

    Article  PubMed  Google Scholar 

  29. • Dai J, Xing L, Jia H, Zhu Y, Zhang S, Hu S, Lin L, Ma L, Liu H, Xu M, Ren X, Yu H, Li L, Zou Y, Zhang S, Mintz GS, Hou J, Yu B. In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study. Eur Heart J. 2018;39:2077–85. This study explains the various mechanisms of plaque disruption and frequencies by age and sex.

    Article  PubMed  Google Scholar 

  30. Farb A, Burke AP, Tang AL, Liang TY, Mannan P, Smialek J and Virmani R. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93:1354–63.

  31. Yahagi K, Davis HR, Arbustini E, Virmani R. Sex differences in coronary artery disease: pathological observations. Atherosclerosis. 2015;239:260–7.

    Article  CAS  PubMed  Google Scholar 

  32. Xing D, Nozell S, Chen Y-F, Hage F, Oparil S. Estrogen and mechanisms of vascular protection. Arterioscler Thromb Vasc Biol. 2009;29:289–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Koskinas KC, Sukhova GK, Baker AB, Papafaklis MI, Chatzizisis YS, Coskun AU, Quillard T, Jonas M, Maynard C, Antoniadis AP, Shi GP, Libby P, Edelman ER, Feldman CL, Stone PH. Thin-capped atheromata with reduced collagen content in pigs develop in coronary arterial regions exposed to persistently low endothelial shear stress. Arterioscler Thromb Vasc Biol. 2013;33:1494–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Yamamoto E, Thondapu V, Poon E, Sugiyama T, Fracassi F, Dijkstra J, Lee H, Ooi A, Barlis P, Jang IK. Endothelial shear stress and plaque erosion: a computational fluid dynamics and optical coherence tomography study. JACC Cardiovasc Imaging. 2019;12:374–5.

    Article  PubMed  Google Scholar 

  35. McElroy M, Kim Y, Niccoli G, Vergallo R, Langford-Smith A, Crea F, Gijsen F, Johnson T, Keshmiri A, White SJ. Identification of the haemodynamic environment permissive for plaque erosion. Sci Rep. 2021;11:7253.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J. 2020;41:1328–36.

    Article  CAS  PubMed  Google Scholar 

  37. Patel H, Aggarwal NT, Rao A, Bryant E, Sanghani RM, Byrnes M, Kalra D, Dairaghi L, Braun L, Gabriel S, Volgman AS. Microvascular disease and small-vessel disease: the nexus of multiple diseases of women. J Womens Health (Larchmt). 2020;29:770–9.

    Article  Google Scholar 

  38. Kramer MC, Rittersma SZ, de Winter RJ, Ladich ER, Fowler DR, Liang YH, Kutys R, Carter-Monroe N, Kolodgie FD, van der Wal AC, Virmani R. Relationship of thrombus healing to underlying plaque morphology in sudden coronary death. J Am Coll Cardiol. 2010;55:122–32.

    Article  PubMed  Google Scholar 

  39. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138:e618–51.

    Article  PubMed  Google Scholar 

  40. Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, Lerman A, Cushman M, Kumbhani DJ, Arslanian-Engoren C, Bolger AF, Beltrame JF. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation. 2019;139:e891–908.

    Article  PubMed  Google Scholar 

  41. Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, De Caterina R, Zimarino M, Roffi M, Kjeldsen K, Atar D, Kaski JC, Sechtem U, Tornvall P. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017;38:143–53.

    PubMed  Google Scholar 

  42. Gue YX, Corballis N, Ryding A, Kaski JC, Gorog DA. MINOCA presenting with STEMI: incidence, aetiology and outcome in a contemporaneous cohort. J Thromb Thrombolysis. 2019;48:533–8.

    Article  CAS  PubMed  Google Scholar 

  43. Berger JS, Elliott L, Gallup D, Roe M, Granger CB, Armstrong PW, Simes RJ, White HD, Van de Werf F, Topol EJ, Hochman JS, Newby LK, Harrington RA, Califf RM, Becker RC, Douglas PS. Sex differences in mortality following acute coronary syndromes. JAMA. 2009;302:874–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Widimsky P, Stellova B, Groch L, Aschermann M, Branny M, Zelizko M, Stasek J, Formanek P. Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: experience from the PRAGUE studies. Can J Cardiol. 2006;22:1147–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Reynolds HR, Srichai MB, Iqbal SN, Slater JN, Mancini GBJ, Feit F, Pena-Sing I, Axel L, Attubato MJ, Yatskar L, Kalhorn RT, Wood DA, Lobach IV, Hochman JS. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124:1414–25.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861–70.

    Article  CAS  PubMed  Google Scholar 

  47. Gue YX, Kanji R, Gati S, Gorog DA. MI with Non-obstructive coronary artery presenting with STEMI: a review of incidence, aetiology, assessment and treatment. Eur Cardiol. 2020;15:e20–e20.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ouldzein H, Elbaz M, Roncalli J, Cagnac R, Carrié D, Puel J, Alibelli-Chemarin MJ. Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion: analysis by intravascular ultrasound. Ann Cardiol Angeiol (Paris). 2012;61:20–6.

    Article  CAS  Google Scholar 

  49. Montone RA, Niccoli G, Fracassi F, Russo M, Gurgoglione F, Cammà G, Lanza GA, Crea F. Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. Eur Heart J. 2018;39:91–8.

    CAS  PubMed  Google Scholar 

  50. Tomaiuolo R, Bellia C, Caruso A, Di Fiore R, Quaranta S, Noto D, Cefalù AB, Di Micco P, Zarrilli F, Castaldo G, Averna MR, Ciaccio M. Prothrombotic gene variants as risk factors of acute myocardial infarction in young women. J Transl Med. 2012;10:235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Ruschitzka F, Ghadri J-R, Cammann VL, Templin C, Yoshida T, Manfredini R, Eitel I, Kosuge M, Nef HM, Bossone E, Citro R, Ueyama T, Corrado D, Migliore F, Tarantini G, Kurisu S, Winchester D, Wittstein IS, Lyon AR, Omerovic E, Bax JJ, Meimoun P, Y.-Hassan S, Horowitz JD, Shimokawa H, Lüscher TF, Prasad A, Deshmukh A, Lerman A, Rihal C, Sharkey S, Dote K, Akashi YJ, Crea F, Galiuto L and Desmet W. International Expert Consensus Document on Takotsubo syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018;39:2032–2046.

  52. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss H-P, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck K-H, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KEJ, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929–38.

    Article  CAS  PubMed  Google Scholar 

  53. Kytö V, Sipilä J, Rautava P. The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Heart. 2013;99:1681.

    Article  PubMed  Google Scholar 

  54. Cocker MS, Abdel-Aty H, Strohm O, Friedrich MG. Age and gender effects on the extent of myocardial involvement in acute myocarditis: a cardiovascular magnetic resonance study. Heart. 2009;95:1925–30.

    Article  CAS  PubMed  Google Scholar 

  55. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006;27:1523–9.

    Article  PubMed  Google Scholar 

  56. Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007;132:809–16.

    Article  PubMed  Google Scholar 

  57. Prasad A, Dangas G, Srinivasan M, Yu J, Gersh BJ, Mehran R, Stone GW. Incidence and angiographic characteristics of patients with apical ballooning syndrome (takotsubo/stress cardiomyopathy) in the HORIZONS-AMI trial: an analysis from a multicenter, international study of ST-elevation myocardial infarction. Catheter Cardiovasc Interv. 2014;83:343–8.

    Article  PubMed  Google Scholar 

  58. Schneider B, Athanasiadis A, Stollberger C, Pistner W, Schwab J, Gottwald U, Schoeller R, Gerecke B, Hoffmann E, Wegner C, Sechtem U. Gender differences in the manifestation of tako-tsubo cardiomyopathy. Int J Cardiol. 2013;166:584–8.

    Article  PubMed  Google Scholar 

  59. Agdamag AC, Patel H, Chandra S, Rao A, Suboc TM, Marinescu K, Ledsky C, Volgman AS. Sex differences in Takotsubo syndrome: a narrative review. Journal of Women’s Health. 2019;29:1122–30.

    Article  PubMed  Google Scholar 

  60. Vallabhajosyula S, Dunlay SM, Murphree DH Jr, Barsness GW, Sandhu GS, Lerman A, Prasad A. Cardiogenic shock in Takotsubo cardiomyopathy versus acute myocardial infarction: an 8-year national perspective on clinical characteristics, management, and outcomes. JACC Heart Fail. 2019;7:469–76.

    Article  PubMed  Google Scholar 

  61. Khera R, Light-McGroary K, Zahr F, Horwitz PA, Girotra S. Trends in hospitalization for Takotsubo cardiomyopathy in the United States. Am Heart J. 2016;172:53–63.

    Article  PubMed  Google Scholar 

  62. Scantlebury DC, Prasad A. Diagnosis of Takotsubo cardiomyopathy. Circ J. 2014;78:2129–39.

    Article  PubMed  Google Scholar 

  63. Fairweather D, Cooper LT Jr, Blauwet LA. Sex and gender differences in myocarditis and dilated cardiomyopathy. Curr Probl Cardiol. 2013;38:7–46.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Stein GY, Herscovici G, Korenfeld R, Matetzky S, Gottlieb S, Alon D, Gevrielov-Yusim N, Iakobishvili Z, Fuchs S. Type-II myocardial infarction–patient characteristics, management and outcomes. PLoS ONE. 2014;9:e84285–e84285.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Sandoval Y, Smith SW, Sexter A, Thordsen SE, Bruen CA, Carlson MD, Dodd KW, Driver BE, Hu Y, Jacoby K, Johnson BK, Love SA, Moore JC, Schulz K, Scott NL and Apple FS. Type 1 and 2 myocardial infarction and myocardial injury: clinical transition to high-sensitivity cardiac troponin I. Am J Med. 2017;130:1431–1439 e4.

  66. Hayes Sharonne N, Kim Esther SH, Saw J, Adlam D, Arslanian-Engoren C, Economy Katherine E, Ganesh Santhi K, Gulati R, Lindsay Mark E, Mieres Jennifer H, Naderi S, Shah S, Thaler David E, Tweet Marysia S, Wood MJ. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137:e523–57.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Adlam D, Alfonso F, Maas A, Vrints C, Committee W. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39:3353–68.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Kim ESH. Spontaneous coronary-artery dissection. N Engl J Med. 2020;383:2358–70.

    Article  CAS  PubMed  Google Scholar 

  69. Tweet Marysia S, Hayes Sharonne N, Pitta Sridevi R, Simari Robert D, Lerman A, Lennon Ryan J, Gersh Bernard J, Khambatta S, Best Patricia JM, Rihal Charanjit S, Gulati R. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126:579–88.

    Article  CAS  PubMed  Google Scholar 

  70. Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, Iwaguro T, Ueno S, Okumoto Y, Akasaka T. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2016;5:263–70.

    Article  PubMed  Google Scholar 

  71. Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, Blin D, Machecourt J. Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients. Eur J Cardiothorac Surg. 2009;35:250–4.

    Article  PubMed  Google Scholar 

  72. Lobo Angie S, Cantu Stephanie M, Sharkey Scott W, Grey Elizabeth Z, Storey K, Witt D, Benson G, Garberich Ross F, Kubota Y, Bairey Merz CN, Henry TD. Revascularization in patients with spontaneous coronary artery dissection and ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2019;74:1290–300.

    Article  CAS  PubMed  Google Scholar 

  73. Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, Robinson S, Vuurmans T, Gao M, Humphries K, Mancini GB. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7:645–55.

    Article  PubMed  Google Scholar 

  74. Saw J, Ricci D, Starovoytov A, Fox R and Buller CE. Spontaneous coronary artery dissection: prevalence of predisposing conditions including fibromuscular dysplasia in a tertiary center cohort. JACC: Cardiovascular Interventions. 2013;6:44–52.

  75. Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS, Holmes DR Jr, Hayes SN, Gulati R. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv. 2014;7:777–86.

    Article  PubMed  Google Scholar 

  76. Saw J, Starovoytov A, Humphries K, Sheth T, So D, Minhas K, Brass N, Lavoie A, Bishop H, Lavi S, Pearce C, Renner S, Madan M, Welsh RC, Lutchmedial S, Vijayaraghavan R, Aymong E, Har B, Ibrahim R, Gornik HL, Ganesh S, Buller C, Matteau A, Martucci G, Ko D, Mancini GBJ. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J. 2019;40:1188–97.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Elkayam U, Jalnapurkar S, Barakkat Mohamad N, Khatri N, Kealey Angela J, Mehra A, Roth A. Pregnancy-associated acute myocardial infarction. Circulation. 2014;129:1695–702.

    Article  PubMed  Google Scholar 

  78. Tweet MS, Hayes SN, Codsi E, Gulati R, Rose CH, Best PJM. Spontaneous coronary artery dissection associated with pregnancy. J Am Coll Cardiol. 2017;70:426–35.

    Article  PubMed  Google Scholar 

  79. Faden MS, Bottega N, Benjamin A, Brown RN. A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium. Heart. 2016;102:1974–9.

    Article  PubMed  Google Scholar 

  80. Havakuk O, Goland S, Mehra A and Elkayam U. Pregnancy and the risk of spontaneous coronary artery dissection: an analysis of 120 contemporary cases. Circulation Cardiovascular interventions. 2017;10.

  81. Tweet MS, Miller VM, Hayes SN. The Evidence on estrogen, progesterone, and spontaneous coronary artery dissection. JAMA Cardiology. 2019;4:403–4.

    Article  PubMed  Google Scholar 

  82. Manalo-Estrella P, Barker AE. Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol. 1967;83:336–41.

    CAS  PubMed  Google Scholar 

  83. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Lancet. 1994;343:311–22.

  84. Weaver WD, White HD, Wilcox RG, Aylward PE, Morris D, Guerci A, Ohman EM, Barbash GI, Betriu A, Sadowski Z, Topol EJ, Califf RM. Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. GUSTO-I investigators JAMA. 1996;275:777–82.

    CAS  PubMed  Google Scholar 

  85. Stone GW, Grines CL, Browne KF, Marco J, Rothbaum D, O’Keefe J, Hartzler GO, Overlie P, Donohue B, Chelliah N, et al. Comparison of in-hospital outcome in men versus women treated by either thrombolytic therapy or primary coronary angioplasty for acute myocardial infarction. Am J Cardiol. 1995;75:987–92.

    Article  CAS  PubMed  Google Scholar 

  86. Tamis-Holland JE, Palazzo A, Stebbins AL, Slater JN, Boland J, Ellis SG, Hochman JS. Benefits of direct angioplasty for women and men with acute myocardial infarction: results of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes Angioplasty (GUSTO II-B) Angioplasty Substudy. Am Heart J. 2004;147:133–9.

    Article  PubMed  Google Scholar 

  87. •• Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J. 2006;27:779–88. This study demonstrates that women derive a greater benefit than men from Primary PCI relative to fibrinolysis particularly in those who present later.

    Article  PubMed  Google Scholar 

  88. Husted S, James SK, Bach RG, Becker RC, Budaj A, Heras M, Himmelmann A, Horrow J, Katus HA, Lassila R, Morais J, Nicolau JC, Steg PG, Storey RF, Wojdyla D, Wallentin L. The efficacy of ticagrelor is maintained in women with acute coronary syndromes participating in the prospective, randomized, PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2014;35:1541–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. •• Schreuder MM, Badal R, Boersma E, Kavousi M, Roos-Hesselink J, Versmissen J, Visser LE and Lennep JERv. Efficacy and safety of high potent P2Y12 inhibitors prasugrel and ticagrelor in patients with coronary heart disease treated with dual antiplatelet therapy: a sex-specific systematic review and meta-analysis. J Am Heart Asso. 2020;9:e014457. This study demonstrates that women derive equal benefit to men from the more potent P2Y12 inhibitors and that they do not have an excess risk of long-term bleeding. This study demonstrates that women derive equal benefit to men from the more potent P2Y12 inhibitors and that they do not have an excess risk of long-term bleeding.

  90. Spirito A, Gragnano F, Corpataux N, Vaisnora L, Galea R, Svab S, Gargiulo G, Siontis GCM, Praz F, Lanz J, Billinger M, Hunziker L, Stortecky S, Pilgrim T, Capodanno D, Urban P, Pocock S, Mehran R, Heg D, Windecker S, Räber L and Valgimigli M. Sex-based differences in bleeding risk after percutaneous coronary intervention and implications for the academic research consortium high bleeding risk criteria. J Am Heart Asso. 2021;10:e021965.

  91. Akhter N, Milford-Beland S, Roe MT, Piana RN, Kao J, Shroff A. Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). Am Heart J. 2009;157:141–8.

    Article  PubMed  Google Scholar 

  92. Tavris DR, Gallauresi BA, Dey S, Brindis R, Mitchel K. Risk of local adverse events by gender following cardiac catheterization. Pharmacoepidemiol Drug Saf. 2007;16:125–31.

    Article  PubMed  Google Scholar 

  93. Le May M, Wells G, So D, Chong AY, Dick A, Froeschl M, Glover C, Hibbert B, Marquis J-F, Blondeau M, Osborne C, MacDougall A, Kass M, Paddock V, Quraishi A, Labinaz M. Safety and efficacy of femoral access vs radial access in ST-segment elevation myocardial infarction: the SAFARI-STEMI Randomized Clinical Trial. JAMA Cardiology. 2020;5:126–34.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, Summaria F, Patrizi R, Borghi A, Di Russo C, Moretti C, Agostoni P, Loschiavo P, Lioy E, Sheiban I, Sangiorgi G. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60:2481–9.

    Article  PubMed  Google Scholar 

  95. •• Huded CP, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett TC, Hantz S, Ellis SG, Podolsky SR, Meldon SW, Kralovic DM, Brosovich D, Smith E, Kapadia SR, Khot UN. 4-step protocol for disparities in STEMI care and outcomes in women. J Am Coll Cardiol. 2018;71:2122–32. This study demonstrated that after initiation of a standardized protocol for all STEMI patients at a single center, sex disparities in guideline directed medical therapy, door-to-balloon time, and adverse events including mortality were completely eliminated.

    Article  PubMed  Google Scholar 

  96. Daugherty SL, Thompson LE, Kim S, Rao SV, Subherwal S, Tsai TT, Messenger JC, Masoudi FA. Patterns of use and comparative effectiveness of bleeding avoidance strategies in men and women following percutaneous coronary interventions: an observational study from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2013;61:2070–8.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Rao SV, Hess CN, Barham B, Aberle LH, Anstrom KJ, Patel TB, Jorgensen JP, Mazzaferri EL Jr, Jolly SS, Jacobs A, Newby LK, Gibson CM, Kong DF, Mehran R, Waksman R, Gilchrist IC, McCourt BJ, Messenger JC, Peterson ED, Harrington RA, Krucoff MW. A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial. JACC Cardiovasc Interv. 2014;7:857–67.

    Article  PubMed  Google Scholar 

  98. Koshy LM, Aberle LH, Krucoff MW, Hess CN, Mazzaferri E Jr, Jolly SS, Jacobs A, Gibson CM, Mehran R, Gilchrist IC, Rao SV. Comparison of radial access, guided femoral access, and non-guided femoral access among women undergoing percutaneous coronary intervention. J Invasive Cardiol. 2018;30:18–22.

    PubMed  Google Scholar 

  99. Vincent F, Spillemaeker H, Kyheng M, Belin-Vincent C, Delhaye C, Piérache A, Denimal T, Verdier B, Debry N, Moussa M, Schurtz G, Porouchani S, Cosenza A, Juthier F, Pamart T, Richardson M, Coisne A, Hertault A, Sobocinski J, Modine T, Pontana F, Duhamel A, Labreuche J and Van Belle E. Ultrasound guidance to reduce vascular and bleeding complications of percutaneous transfemoral transcatheter aortic valve replacement: a propensity score–matched comparison. J Am Heart Asso. 2020;9:e014916.

  100. Soverow J, Oyama J, Lee MS. Adoption of routine ultrasound guidance for femoral arterial access for cardiac catheterization. J Invasive Cardiol. 2016;28:311–4.

    PubMed  Google Scholar 

  101. Jia H, Dai J, Hou J, Xing L, Ma L, Liu H, Xu M, Yao Y, Hu S, Yamamoto E, Lee H, Zhang S, Yu B, Jang I-K. Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study). Eur Heart J. 2017;38:792–800.

    Article  CAS  PubMed  Google Scholar 

  102. Xing L, Yamamoto E, Sugiyama T, Jia H, Ma L, Hu S, Wang C, Zhu Y, Li L, Xu M, Liu H, Bryniarski K, Hou J, Zhang S, Lee H, Yu B and Jang I-K. EROSION Study (Effective Anti-Thrombotic Therapy Without Stenting: Intravascular Optical Coherence Tomography–Based Management in Plaque Erosion). Circulation: Cardiovascular Interventions. 2017;10:e005860.

  103. Prati F, Uemura S, Souteyrand G, Virmani R, Motreff P, Di Vito L, Biondi-Zoccai G, Halperin J, Fuster V, Ozaki Y and Narula J. OCT-based diagnosis and management of STEMI associated with intact fibrous cap. JACC: Cardiovascular Imaging. 2013;6:283-287.

  104. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet J-P, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO and Group ESD. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018;40:87–165.

    Google Scholar 

  105. Thiele H, Akin I, Sandri M, Fuernau G, de Waha S, Meyer-Saraei R, Nordbeck P, Geisler T, Landmesser U, Skurk C, Fach A, Lapp H, Piek JJ, Noc M, Goslar T, Felix SB, Maier LS, Stepinska J, Oldroyd K, Serpytis P, Montalescot G, Barthelemy O, Huber K, Windecker S, Savonitto S, Torremante P, Vrints C, Schneider S, Desch S, Zeymer U. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med. 2017;377:2419–32.

    Article  PubMed  Google Scholar 

  106. Thiele H, Akin I, Sandri M, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, Eitel I, Nordbeck P, Geisler T, Landmesser U, Skurk C, Fach A, Jobs A, Lapp H, Piek JJ, Noc M, Goslar T, Felix SB, Maier LS, Stepinska J, Oldroyd K, Serpytis P, Montalescot G, Barthelemy O, Huber K, Windecker S, Hunziker L, Savonitto S, Torremante P, Vrints C, Schneider S, Zeymer U, Desch S. One-year outcomes after PCI strategies in cardiogenic shock. N Engl J Med. 2018;379:1699–710.

    Article  PubMed  Google Scholar 

  107. de Waha S, Jobs A, Eitel I, Poss J, Stiermaier T, Meyer-Saraei R, Fuernau G, Zeymer U, Desch S, Thiele H. Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2018;7:28–37.

    Article  PubMed  Google Scholar 

  108. Rubini Gimenez M, Zeymer U, Desch S, de Waha-Thiele S, Ouarrak T, Poess J, Meyer-Saraei R, Schneider S, Fuernau G, Stepinska J, Huber K, Windecker S, Montalescot G, Savonitto S, Jeger RV and Thiele H. Sex-specific management in patients with acute myocardial infarction and cardiogenic shock. Circulation: Cardiovascular Interventions. 2020;13:e008537.

  109. Vaccarino V, Parsons L, Every NR, Barron HV and Krumholz HM. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 1999;341:217–25.

  110. Vallabhajosyula S, Ya’Qoub L, Singh M, Bell MR, Gulati R, Cheungpasitporn W, Sundaragiri PR, Miller VM, Jaffe AS, Gersh BJ, Holmes DR, Jr. and Barsness GW. Sex disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction in the young. Circ Heart Fail. 2020;13:e007154.

  111. Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, Jain D, Gotsis W, Ahmed A, Frishman WH and Fonarow GC. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc. 2014;3:e000590.

  112. Hochman Judith S, Boland J, Sleeper Lynn A, Porway M, Brinker J, Col J, Jacobs A, Slater J, Miller D, Wasserman H, Menegus Mark A, Talley JD, McKinlay S, Sanborn T, LeJemtel T. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Circulation. 1995;91:873–81.

    Article  Google Scholar 

  113. Wong SC, Sleeper LA, Monrad ES, Menegus MA, Palazzo A, Dzavik V, Jacobs A, Jiang X and Hochman JS. Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. J Am Coll Cardiol. 2001;38:1395–401.

  114. Wong SC, Sleeper LA, Monrad ES, Menegus MA, Palazzo A, Dzavik V, Jacobs A, Jiang X, Hochman JS. Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. 2001;38:1395–401.

    CAS  Google Scholar 

  115. Edep ME, Brown DL. Effect of early revascularization on mortality from cardiogenic shock complicating acute myocardial infarction in California. Am J Cardiol. 2000;85:1185–8.

    Article  CAS  PubMed  Google Scholar 

  116. Antoniucci D, Migliorini A, Moschi G, Valenti R, Trapani M, Parodi G, Bolognese L, Santoro GM. Does gender affect the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock who undergo percutaneous coronary intervention? Catheter Cardiovasc Interv. 2003;59:423–8.

    Article  PubMed  Google Scholar 

  117. Antoniucci D, Valenti R, Moschi G, Migliorini A, Trapani M, Santoro GM, Bolognese L, Cerisano G, Buonamici P, Dovellini EV. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol. 2002;89:121–5.

    Article  PubMed  Google Scholar 

  118. Tehrani BN, Truesdell AG, Psotka MA, Rosner C, Singh R, Sinha SS, Damluji AA, Batchelor WB. A standardized and comprehensive approach to the management of cardiogenic shock. JACC Heart Fail. 2020;8:879–91.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Bohm M, Ebelt H, Schneider S, Schuler G, Werdan K. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367:1287–96.

    Article  CAS  PubMed  Google Scholar 

  120. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Bohm M, Ebelt H, Schneider S, Werdan K, Schuler G. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382:1638–45.

    Article  PubMed  Google Scholar 

  121. Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, Dirschinger J, Kastrati A, Schomig A. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52:1584–8.

    Article  PubMed  Google Scholar 

  122. Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ, Vis MM, Wykrzykowska JJ, Koch KT, Baan J, de Winter RJ, Piek JJ, Lagrand WK, de Mol BA, Tijssen JG, Henriques JP. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2017;69:278–87.

    Article  PubMed  Google Scholar 

  123. Basir MB, Kapur NK, Patel K, Salam MA, Schreiber T, Kaki A, Hanson I, Almany S, Timmis S, Dixon S, Kolski B, Todd J, Senter S, Marso S, Lasorda D, Wilkins C, Lalonde T, Attallah A, Larkin T, Dupont A, Marshall J, Patel N, Overly T, Green M, Tehrani B, Truesdell AG, Sharma R, Akhtar Y, McRae T 3rd, O’Neill B, Finley J, Rahman A, Foster M, Askari R, Goldsweig A, Martin S, Bharadwaj A, Khuddus M, Caputo C, Korpas D, Cawich I, McAllister D, Blank N, Alraies MC, Fisher R, Khandelwal A, Alaswad K, Lemor A, Johnson T, Hacala M, O’Neill WW. Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv. 2019;93:1173–83.

    PubMed  Google Scholar 

  124. Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S, Khandelwal A, Hanson I, George A, Ashbrook M, Blank N, Abdelsalam M, Sareen N, Timmis SBH, O’Neill Md WW. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv. 2018;91:454–61.

    Article  PubMed  Google Scholar 

  125. Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC, Singh R, Psotka M, Shah P, Cooper LB, Rosner C, Raja A, Barnett SD, Saulino P, deFilippi CR, Gurbel PA, Murphy CE, O’Connor CM. Standardized team-based care for cardiogenic shock. J Am Coll Cardiol. 2019;73:1659–69.

    Article  PubMed  Google Scholar 

  126. Taleb I, Koliopoulou Antigone G, Tandar A, McKellar Stephen H, Tonna Joseph E, Nativi-Nicolau J, Alvarez Villela M, Welt F, Stehlik J, Gilbert Edward M, Wever-Pinzon O, Morshedzadeh Jack H, Dranow E, Selzman Craig H, Fang James C, Drakos SG. Shock team approach in refractory cardiogenic shock requiring short-term mechanical circulatory support. Circulation. 2019;140:98–100.

    Article  PubMed  PubMed Central  Google Scholar 

  127. Lee F, Hutson JH, Boodhwani M, McDonald B, So D, De Roock S, Rubens F, Stadnick E, Ruel M, Le May M, Labinaz M, Chien K, Garuba HA, Mielniczuk LM, Chih S. Multidisciplinary code shock team in cardiogenic shock: a Canadian Centre Experience. CJC Open. 2020;2:249–57.

    Article  PubMed  PubMed Central  Google Scholar 

  128. • Basir MB, Schreiber TL, Grines CL, Dixon SR, Moses JW, Maini BS, Khandelwal AK, Ohman EM, O’Neill WW. Effect of early initiation of mechanical circulatory support on survival in cardiogenic shock. Am J Cardiol. 2017;119:845–51. This manuscript suggests that early mechanical circulatory support in women with AMICS may be more beneficial than in men and narrow the sex gap in mortality.

    Article  PubMed  Google Scholar 

  129. Shah T, Lansky A, Grines C, O’Neill W, Moses J, Chieffo A, Kapur N and Chou J. Mechanical circulatory support in myocardial infarction complicated by cardiogenic shock: impact of sex and timing. J Soc Cardio Angio Inter. 2022;1.

  130. Joseph SM, Brisco MA, Colvin M, Grady KL, Walsh MN, Cook JL and gen VADWG. Women with cardiogenic shock derive greater benefit from early mechanical circulatory support: an update from the cVAD registry. J Inter Cardio. 2016;29:248–56.

  131. Ani C, Pan D, Martins D and Ovbiagele B. Age- and sex-specific in-hospital mortality after myocardial infarction in routine clinical practice. Cardiol Res Pract. 2010;2010:752765.

  132. Nguyen JT, Berger AK, Duval S, Luepker RV. Gender disparity in cardiac procedures and medication use for acute myocardial infarction. Am Heart J. 2008;155:862–8.

    Article  PubMed  PubMed Central  Google Scholar 

  133. Hvelplund A, Galatius S, Madsen M, Rasmussen JN, Rasmussen S, Madsen JK, Sand NP, Tilsted HH, Thayssen P, Sindby E, Hojbjerg S, Abildstrom SZ. Women with acute coronary syndrome are less invasively examined and subsequently less treated than men. Eur Heart J. 2010;31:684–90.

    Article  PubMed  Google Scholar 

  134. Conrotto F, D’Ascenzo F, Humphries KH, Webb JG, Scacciatella P, Grasso C, D’Amico M, Biondi-Zoccai G, Gaita F, Marra S. A meta-analysis of sex-related differences in outcomes after primary percutaneous intervention for ST-segment elevation myocardial infarction. J Interv Cardiol. 2015;28:132–40.

    Article  PubMed  Google Scholar 

  135. Bugiardini R, Manfrini O, Cenko E. Female sex as a biological variable: a review on younger patients with acute coronary syndrome. Trends Cardiovasc Med. 2019;29:50–5.

    Article  PubMed  Google Scholar 

  136. Sabbag A, Matetzky S, Porter A, Iakobishvili Z, Moriel M, Zwas D, Fefer P, Asher E, Beigel R, Gottlieb S, Goldenberg I and Segev A. Sex differences in the management and 5-year outcome of young patients (<55 years) with acute coronary syndromes. Am J Med. 2017;130:1324 e15–1324 e22.

  137. Saw J, Mancini GBJ, Humphries KH. Contemporary review on spontaneous coronary artery dissection. J Am Coll Cardiol. 2016;68:297–312.

    Article  PubMed  Google Scholar 

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Shah, T., Kapadia, S., Lansky, A.J. et al. ST-Segment Elevation Myocardial Infarction: Sex Differences in Incidence, Etiology, Treatment, and Outcomes. Curr Cardiol Rep 24, 529–540 (2022). https://doi.org/10.1007/s11886-022-01676-7

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