RESUMEN
BACKGROUND: It is uncertain whether gender differences in outcome after primary percutaneous coronary intervention (PCI) are only attributable to different baseline characteristics or additional factors. METHODS: Databases of two German myocardial infarction network registries were combined with a total of 1104 consecutive patients admitted with acute ST-elevation myocardial infarction (STEMI) and treated according to standardized protocols. RESULTS: Approximately 25% of patients were females. Mean age (69 vs 61 years), incidence of diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%) was significantly higher compared to males. Mean prehospital delay was numerically longer in females (227 vs 209 min) as was in hospital delay (35 vs 30 min). PCI was finally performed in 92% of females and 95% of males with comparable procedural success (95% vs 97%). Use of drug eluting stents (55% vs 68%) and application of GP 2b 3a blockers (75% vs 89%) was significantly less frequent in women. At discharge, prescription of beta blockers and lipid lowering drugs was also significantly lower in females (84% vs 90% and 71% vs 84%). Unadjusted in-hospital mortality was significantly higher in females (10% vs 5%) without attenuation after 12 months. Adjusted mortality however did not differ significantly between genders. CONCLUSION: Higher unadjusted mortality in females after primary PCI was accompanied by significant differences in baseline characteristics, interventional approach and secondary prophylaxis in spite of the same standard of care. Lower guideline adherence seems to be less gender specific but rather a manifestation of the risk-treatment paradox.
Asunto(s)
Adhesión a Directriz , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/mortalidad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Anciano de 80 o más Años , Stents Liberadores de Fármacos , Femenino , Alemania/epidemiología , Adhesión a Directriz/normas , Disparidades en Atención de Salud/normas , Mortalidad Hospitalaria , Humanos , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/normas , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
Signals from pharmacovigilance studies indicate that women are at higher risk for adverse drug reactions (ADRs) due to diuretics. Despite the long-term use of torasemide, there are few studies investigating gender differences of torasemide pharmacokinetics in the hospital setting. Therefore, torasemide pharmacokinetics were investigated in 90 patients (45 women, 45 men) during steady-state conditions. Torasemide elimination was significantly reduced in women compared with men (eg, body-weight-normalized area under the concentration-time curve: 42.1 +/- 20.4 vs 30.9 +/- 10.3 kg.h/L; P < .001). Among the investigated genetic factors [SLC22A11(OAT4), SLCO1B1(OATP1B1), CYP2C9], only the SLCO1B1c.521T>C polymorphism had a significant influence on torasemide pharmacokinetics. Using cell lines expressing OATP1B1, the authors identified torasemide as OATP1B1 substrate (K(m) = 6.2 microM) with a significant reduction of uptake by the 521C-variant. Taken together, gender differences in torasemide pharmacokinetics are likely to contribute to a higher rate of ADRs in women, which has, for example, been observed in a German Pharmacovigilance Project with 66% of hospitalizations due to torasemide ADRs occurring in women.
Asunto(s)
Diuréticos/farmacocinética , Transportadores de Anión Orgánico/genética , Sulfonamidas/farmacocinética , Línea Celular , Diuréticos/administración & dosificación , Diuréticos/efectos adversos , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Transportador 1 de Anión Orgánico Específico del Hígado , Masculino , Mutagénesis Sitio-Dirigida , Transportadores de Anión Orgánico/metabolismo , Polimorfismo Genético , Factores Sexuales , Sulfonamidas/administración & dosificación , Sulfonamidas/efectos adversos , TorasemidaRESUMEN
Takotsubo cardiomyopathy (TTC) is a cardiac entity appreciated only recently mimicking acute myocardial infarction, often affects post-menopausal women and is triggered by preceding emotional or physical stress. Pathogenesis of TTC is unknown, recurrence of TTC in one individual and familial predisposition occurs. Expression profiling of cardiac genes in the acute phase of TTC are not enough analyzed and are a component of future research. We report for the first time on a female individual with TTC, who happened to be carrier of an FMR1 gene mutation, alleles of an intermediate size between 40-55 triplet premutations.
Asunto(s)
Proteína de la Discapacidad Intelectual del Síndrome del Cromosoma X Frágil/genética , Síndrome del Cromosoma X Frágil/genética , Cardiomiopatía de Takotsubo/genética , Anciano , Southern Blotting , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Imagen por Resonancia Cinemagnética , Mutación , Ahogamiento Inminente , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Cardiomiopatía de Takotsubo/diagnósticoRESUMEN
PURPOSE: To assess the technical feasibility and biocompatibility of a novel stent based on poly(L-lactide) (PLLA) and poly(4-hydroxybutyrate) (P4HB) for peripheral vascular applications. METHODS: A polytetrafluoroethylene aortobi-iliac graft was implanted in 5 pigs through a midline abdominal incision. After transverse graft limb incision, 5 PLLA/P4HB stents and 5 metal stents (316L stainless steel) were randomly deployed at both iliac anastomotic sites with 6-mm balloon catheters. Angiography was performed to determine patency prior to sacrifice at 6 weeks. Stented segments were surgically explanted and processed for quantitative histomorphometry. Vascular injury and inflammation scores were assigned to the stented iliac segments. RESULTS: No animals were lost during follow-up. All PLLA/P4HB stents were deployed within 2 minutes by balloon inflation to 8 bars without rupture of the stent struts or anastomotic suture. All stents were patent on postprocedural angiography. Histological analysis showed no signs of excessive recoiling or collapse. PLLA/P4HB stents demonstrated decreased residual lumen area and increased neointimal area after 6 weeks (12.27+/-0.62 and 8.40+/-1.03 mm(2), respectively) compared to 316L stents (13.54+/-0.84 and 6.90+/-1.11 mm(2), respectively) as the result of differences in stent areas (PLLA/P4HB: 4.31+/-0.15 mm(2); 316L: 2.73+/-0.29 mm(2)). Vascular injury scores showed only mild vascular trauma for all stents (PLLA/P4HB: 0.41+/-0.59; 316L: 0.32+/-0.47). Inflammatory reaction was slightly higher around PLLA/P4HB stent struts (1.39+/-0.52) compared to 316L (1.09+/-0.50). CONCLUSION: Rapid balloon expansion of PLLA/P4HB stents is feasible without risk of strut rupture. PLLA/P4HB stents provide adequate mechanical stability after iliac anastomotic stenting in pigs. Smaller residual luminal areas in the PLLA/P4HB stents might have been caused by tissue ingrowth into the larger strut interspaces due to higher strut thickness (stent area) in this group. This limitation needs to be addressed in future work on the stent design.