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Grandes números en ECV en la mujer
Dra. Antonia Sambola Ayala
Hospital Universitari Vall d'Hebron, Barcelona

2. Antonia Sambola Ayala
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Cardiovascular disease in women
The Lancet Comission on cardiovascular diseases in women, 2021

3. Antonia Sambola Ayala
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Timmis A et al. EHJ 2022; 43: 716–799
Incidence, prevalence of ischaemic heart disease and causes of death
in European Society of Cardiology member countries
46% 38%

4. Antonia Sambola Ayala
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?
INE 2016

5. Antonia Sambola Ayala
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45%
25%
64%
Jackson J et al. Heart 2022
80% of women ≥75 years old have Hypertension. Only 29% have adequate BP control
Risk factors for women in some lifecycles

6. Antonia Sambola Ayala
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Overview of ACS in Spain
Acute Coronary Syndromes*
445,145 Cases – Spain 2005-2015
Hospital Admissions
UA/NSTEMI†
STEMI
Rodriguez-Padial L. Rev Esp Cardiol, 2020;66:472-81
Sambola A. Rev Esp Cardiol 2021;74:927-934
N= 172,738 (39%)
Women: 34%
N=272,472 (61%)
Women: 29%

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35
30
25
20
15
10
5
0
31%
21%
1995-99 2010-14
French women < 65 years old US women < 55 years old
Gabet A et al. Eur Heart J 2017 Arora S et al. Circulation 2019
ACS increases in young women
Smoking and obesity were associated with the increase of STEMI in younger women

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Younger women are less likely to receive revascularization for STEMI
Have higher in-hospital mortality as compared with younger men.
Use of PCI for STEMI and in-hospital mortality have increased
4.5% vs 3.0% Increased of 11% in 7 years
Period 2004 to 2011: N= 632,930 <60 years
(22.5% women)
71.2% vs 63.0%
4.2% vs 3.86 days
Khera Sh et al. JACC 2015
Bias in the Care of Young women with STEMI

9. Antonia Sambola Ayala
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0%
10%
20%
30%
40%
50%
60%
70%
80%
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
% ICP in STEMI
Men Women
43% of women vs 24% of men did not receive any reperfusion
in 2015
Sambola A et al, Rev Esp Cardiol 2021;74:927-934
N=349,940 (29% women)
In-hospital. Sex-based treatment difference in STEMI care
Lower rate of PCI in women

10. Antonia Sambola Ayala
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Cenko, E. et al. J Am Coll Cardiol. 2019;74:2379–89.
Associated factors with HF:
>60 years women
>120 minutes delay
N=10,443 (29.8% women)
Women with HF de novo had higher 30-day mortality than men: 9.6% vs 5.9% <0.0001
Killip class >II
20% Men 25% Women
p<0.0001
Women are at higher risk to develop de novo heart failure after STEMI

11. Antonia Sambola Ayala
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1,941 patients (39% women)
92% WOMEN had chest pain
91% MEN had chest pain
Gulati M, JACC 2022
Ferry AV J Am Heart Assoc. 2019;8:e012307
Huded et al JACC 2018;19:2122-32
Sambola A et al., European Cardiology Review (in press)
Vidal M ©
>12% delay in women
Initial management of women with STEMI

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Network system: transfer ECG to cardiologist
Emergency department: ACTIVATION CATH LAB!
Early triage: Administration of guided-directed medical therapy
Immediate transfer to available cardiac cath
Radial first approach for PCI
STEMI Protocol 4-steps
How reduce the bias in the STEMI care and outcomes in women?
Huded et al. JACC 2018; 19: 2122-32

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Protocol for Disparities in STEMI Care and Outcomes in Women
N=1,272
32% women
Huded JACC 2018;19:2122-32

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25%
N= 68,730 (29%) women
Women are more likely to have MINOCA: 10% vs 4%
Women were less likely to:
- Undergo coronary angiography (69.7% vs. 76.2%)
- To be treated with PCI (49.2% vs. 59.0%)
- To receive DAPT (79% vs 86%; p<0.001)
10%
?
Sarma A JACC 2019:3012-22
Kunadian V Heart 2020
Management of women with Non-STEMI
Higher mortality rates were associated with an invasive strategy
in high-risk women
10%
25%
?

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The GRACE 2.0 score underestimated in-hospital mortality risk in female patients, favouring their incorrect stratification
to the low-to-intermediate risk group, for which the score does not indicate early invasive treatment.
Risk stratification is appropiate for women with Non-STEMI?
GRACE 3.0 score
Wenzel FA, Lancet 2022, 3 sept;400:744–56

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Clinical Presentations of Underlying Etiologies Contributing to MINOCA
Minissian MB, et al. J Am Coll Cardiol. 2022;80:1014–1022
Pasupathy S, et al. Circulation. 2015;131:861–870
50% patients with MINOCA are women
50% MINOCA < 60 years
25% MINOCA < 50 years
25% of patients with MINOCA will experience angina in the subsequent 12 months

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Knowledge, attitudes and beliefs regarding CV in women
Merz B, JACC 2017;70:123-32

18. Antonia Sambola Ayala
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Participation of women in clinical trials

19. Antonia Sambola Ayala
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Bias in the care of women with ACS and steps to improve outcomes
Cader FA. J. Cardiovasc. Dev. Dis. 2022; 9:239-45