Rosanna Abbaterosanna.abbate@unifi.itUniversità di FirenzeAOU Careggi

received fees and research supportfrom Bayer, Boeringer Ingelheim, Eli Lilly, GSK, IL, Pfizer, Sanofi Aventis, Siemens

Incidenza infarto miocardico: tassi specifici per età

e genere  (per 100.000 abitanti), Toscana, anno 2012

(fonte: elaborazione ARS su archivio SDO)

MALES

(n= 388)

FEMALES

(n=164)

p

Age, yrs* 69(59-77) 79(69-86) <0.001

Current smokers (%) 28.4 8.54 <0.001

Hypertension (%) 54.4 62.2 0.090

Hyperlipemia (%) 28.4 31.1 0.516

Diabetes mellitus (%) 23.2 31.1 0.052

Baseline characteristics of STEMI (n=552) patients

enrolled in AMI FLORENCE 2 REGISTRY

MALES

(n= 542)

FEMALES

(n=402)

p

Age, yrs* 75 (66-82) 81 (73-86) <0.001

Current smokers (%) 22.1 8.5 <0.001

Hypertension (%) 66.4 72.6 0.041

Hyperlipemia (%) 31.7 31.3 0.898

Diabetes mellitus (%) 29.3 30.4 0.005

Baseline characteristics of NSTEMI (n=944)

patients enrolled in AMI FLORENCE 2 REGISTRY

Prevalenza dei pazienti con ipertensione arteriosa: tassi  specifici per età

e genere (per 1.000 abitanti), Toscana, anno 

2012 (fonte: elaborazione ARS ‐

archivio MaCro)

Pazienti con ipertensione arteriosa in trattamento con farmaci  antiipertensivi: pazienti (%) che effettuano almeno una volta l’anno alcuni 

esami ematochimici utili per il monitoraggio e la prevenzione delle  complicanze della malattia, Toscana, anno 2012

(fonte: elaborazione ARS ‐

archivio MaCro)

MALES FEMALES PHistory of MI 31.4 23.1 0.005History of angina, onset <=1month 16.2 8.5 0.001

0.001“ “ “ “ >1month 18.5 16.7

History of PCI 24.9 16.4 0.002History of CABG 9.2 6.0 0.066History of chronic heart failure 8.7 13.4 0.019History of atrial fibrillation 2.6 11.6 <0.001History of Stroke 7.6 13.9 0.001History of PVD 18.8 11.0 0.001History of COPD 18.1 13.4 0.055History of CRF, creatinine 1.5-2.5 mg/dL 9.8 9.0 0.308

History of CRF, creatinine > 2.5 mg/dL 2.3 1.8

History of cancer (onset <= 5 years) 8.5 6.7 0.486

History of cancer (onset >5 years) 5.4 6.5

History of Depression 2.6 11.0 <0.001History of Anemia 14.2 15.7 0.531

Baseline characteristics of STEMI (n=944) patients enrolled in AMI FLORENCE 2 REGISTRY -Medical History

(%)

Pazienti ricoverati per IMA : percentuale casi trattati con interventi  riperfusivi coronarici entro 1 giorno dal ricovero suddivisa per

tipo IMA e 

genere, Toscana, anno 2009 (fonte Registro toscano infarto miocardico acuto)

Invasive procedures during hospitalization

in STEMI

(n=552)

patients enrolled in AMI FLORENCE 2 REGISTRY MA L ES

(n= 3 8 8)

FE M A L ES

(n= 1 64)

p

Cardiac pro c edu r es, %

C a the t er iz a tion 92 .8 84 .8 0. 00 3

C a the t er iz a tion , Š 4 8 h 90 .0 80 .0 0. 00 5

PCI 85 .8 72 .6 CA B G 2.8 1.2 No r epe r f u sion 11 .3 26 .2

<0 .0 01

An g iogr a p h ic f indi n gs, %

L e f t m a in d is e a s e 7.2 3.6 0. 13 3

N ° of di se a s ed v e s se ls*:

- 1 36 .4 35 .3

- 2 26 .4 31 .0 <0 .0 01

- 3 35 .0 23 .0

MALES (n= 38 8)

FEMALES (n=16 4)

p

Acut e medicat ion, % Aspir in Š 24 h 92 . 5 86 . 6 0. 058 Clopidog rel, Š 2 4 h 73 . 5 59 . 2 0. 001 GP IIb/IIIa inhibitors Š 24 h 64 . 2 43 . 9 0. 001 Any ant icoagulant during hospital ization

91 . 0 90 . 2 0. 785

Unfr actioned hepar in 78 . 1 68 . 9 0. 022 LMWH 26 . 8 31 . 1 0. 305 Fondaparinux 4.6 7.9 0. 125 B et a- blocker s du r ing hospit alizat ion 75 . 3 73 . 8 0. 715

Pharmacological therapies at admission in STEMI

(n=552) patients enrolled in AMI FLORENCE 2 REGISTRY

AMI FLORENCE  2High on‐treatment platelet reactivity (HPR)  

according to gender Verify P2Y12: PRU≥240

%

HPR No HPR

49%

70

60

50

40

30

030%

P<0.000170%

51%

= Female (n=377)= Male (n=683)

P<0.0001

Residual Platelet Reactivity, Bleedings, and Adherence toTreatment in Patients Having Coronary Stent Implantation

Treated With Prasugrel

Parodi et al., AJC 2011

Multivariate analysis OR FOR BLEEDING EVENTS

Female gender: OR= 2.2 (1.08-4.45), p=0.029

Uso di statine dopo infarto miocardico acuto: percentuale pazienti trattati  nell’anno successivo alla dimissione dall’ospedale suddivisa per età

e 

genere, area fiorentina, anno 2009 (fonte: Balzi et al, 2012b)

Prevalenza dello scompenso cardiaco: tassi specifici per età

e  genere (per 1.000 abitanti), Toscana, anno 2012

(fonte: elaborazione ARS ‐

archivio MaCro)

Pazienti con scompenso cardiaco pazienti (%) che effettuano almeno una  volta l’anno alcuni esami ematochimici utili per il monitoraggio della 

malattia e con erogazione di ACE inbitori o sartani e di  betabloccanti,  Toscana, anno 2012

(fonte: elaborazione ARS ‐

archivio MaCro

Prevalenza dei pazienti con pregresso ictus cerebrale: tassi specifici per età e genere (per 1.000 abitanti), Toscana, anno 2012 (fonte: elaborazione ARS - archivio MaCro)

Pazienti con pregresso ictus cerebrale: pazienti (%) che effettuano almeno  una volta l’anno alcuni esami ematochimici utili per il monitoraggio della 

malattia e con prescrizione di terapia antiaggregante piastrinica, Toscana,  anno 2012

(fonte: elaborazione ARS ‐

archivio MaCro 

Poli et al Thromb Haemosta 2009

Quality of anticoagulationWomen n=1657;          Men n=1358

Below Within Above

%

Therapeutic

rangeMalesFemales CENTRO TROMBOSI Firenze

0.02

ns

ns

Multivariate model controlling for stroke

risk factorsN=780

Female gender

Age

History of previous TIA/Stroke

Hypertension

Diabetes

Coronary artery disease

Left ventricular dysfunction

2.2

1.0

8.4

2.5

2.3

1.9

1.4

0.050.010.0000.030.060.20.74

OR p

1.0-4.9

1.0-1.1

3.3-21.6

1.0-5.9

1.0-5.8

0.7-4.9

0.6-3.7

95% CI

Centro Trombosi, FiPoli et al Thromb Haemost, 2009

Cox regression analysis after correction for age confirmed the higher rate of thrombotic events in females respect to males HR 2.3; 95% CI 1.2-4.4; p=0.009.

Strokes occurring in females were more disabling: RR for severe and fatal stroke, defined according to Modified Rankin scale, of females vs males was 3.1 (95% CI 1.3- 6.5; p=0.001).

Centro Trombosi, Fi Poli et al, Thromb Haemost 2009

A GENDER-SPECIFIC RISK FACTOR:Hypertensive pregnancy/preterm delivery/

preeclampsia

NORTHERN FINLAND BIRTH COHORT 1966,  N=12055

COMMISSIONE MEDICINA DI GENERE

Valutazione del rischio vascolare in donne con pregressa storia di eventi ostetrici negativi

Celesti AM, Abbate R, Baggiore C, Di Tommaso MR, Fatini C, Maffei S, Panigada G, Zuppiroli A

Obiettivi del progetto:

Prevenzione primaria della patologia cardiovascolare nelle donne apparentemente sane:

con storia personale di eventi ostetrici avversi

in gravidanza a rischio di complicanze ostetriche placenta-mediate

Valutazione del profilo di rischio individuale stimato sulla base delle carte del rischio della Società Europea di Cardiologia (ESC/EAS, 2011) e al CVD Framingham score

Effettuazione di un follow-up per la rivalutazione clinica ed il controllo dei fattori di rischio cardiovascolare

CONDIVISIONE DI UNA CARTA DEL RISCHIO VASCOLARE GLOBALE PER:

Donne con storia di eventi ostetrici negativi (ipertensione in gravidanza, preeclampsia, ritardo di crescita fetale, perdite fetali dopo la 20° settimana, poliabortività, abruptio placentae, diabete gestazionale)

Donne in gravidanza a potenziale rischio di sviluppare tali patologie

MALES FEMALES PHistory of MI 16.5 9.2 0.024

History of angina, onset <=1month 8.5 9.2 0.166

“ “ “ “ >1month 12.9 7.3

History of PCI 12.4 6.1 0.028History of CABG 2.6 1.8 0.596History of chronic heart failure 3.1 6.7 0.052History of atrial fibrillation 2.6 11.6 <0.001History of Stroke 5.9 11.6 0.022

History of PVD 9.3 8.5 0.781History of COPD 9.0 14.6 0.051History of CRF, creatinine 1.5-2.5 mg/dL 2.1 4.3 0.328

History of CRF , creatinine > 2.5 mg/dL 2.3 1.8

History of cancer (onset <= 5 years) 6.4 4.9 0.046

History of cancer (onset >5 years) 2.8 7.3

History of Depression 1.6 6.1 0.004History of Anemia 5.4 11.0 0.020

Baseline characteristics of STEMI (n=552) patients enrolled in AMI FLORENCE 2 REGISTRY -

Medical History

(%)

MALES (n= 54 2)

FEMALES (n=40 2)

p

Acut e medicat ion, % Aspir in Š 24 h 83 . 8 80 . 9 0. 608 Clopidog rel, Š 2 4 h 43 . 9 27 . 6 0. 001 GP IIb/IIIa inhibitors Š 24 h 17 . 7 8.2 0. 001 Any ant icoagulant during hospital ization

82 . 8 77 . 6 0. 044

Unfra ctioned hepar in 50 . 4 30 . 6 <0.0 01 LMWH 40 . 4 43 . 3 0. 375 Fondaparinux 14 . 0 16 . 7 0. 262 B et a- blocker s du r ing hospit alizat ion 67 . 9 68 . 2 0. 932

Pharmacological therapies at admission in NSTEMI

(n=944) patients enrolled in AMI FLORENCE 2 REGISTRY

0.00

0.05

0.10

0.15

0.20

0 5 10 15Months of follow-up

Males Females

Observed mortality

0.0

5.1

.15

.2

0 5 10 15Months of follow-up

MA LES FEMALE S

Estimated mortality according to multivariable Cox model

One-year observed and estimated (multivariable Cox model) risk of death by gender in STEMI patients (n=552)

enrolled in AMI FLORENCE 2 REGISTRY

OBSERVED MORTALITY Death 41/164 (25.0%)

Death 50/388 (13.1%)

ESTIMATED MORTALITY ACCORDING TO MULTIVARIATE

COX MODEL

P<0.001

n.s.

Females vs males:HR 1.33 (0.83‐2.12)

p=0.239

0.00

0.05

0.10

0.15

0.20

0 5 10 15Months of follow-up

Males Females

Observed mortality

0.0

5.1

.15

.2

0 5 10 15Months of follow-up

MALES FEMALES

Estimated mortality according to multivariable Cox model

One-year observed and estimated (multivariable Cox model) risk of death by gender in NSTEMI patients

(n=944) enrolled in AMI FLORENCE 2 REGISTRY

OBSERVED MORTALITY

Death 79/542 (14.6 %)

ESTIMATED MORTALITY ACCORDING TO MULTIVARIATE

COX MODEL

P<0.001

n.s.

Females vs males:HR 1.22 (0.87‐1.71)

p=0.257

Death 91/402 (22.6%)

… and more