{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:40:47Z","timestamp":1792194047230,"version":"4.4.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Studies of sex-based differences in older adults with acute myocardial infarction (AMI) have yielded mixed results. We, therefore, sought to evaluate sex-based differences in presentation characteristics, treatments, functional impairments, and in-hospital complications in a large, well-characterized population of older adults (\u226575 years) hospitalized with AMI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              We analyzed data from participants enrolled in SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction)\u2014a prospective observational study consisting of 3041 older patients (44% women) hospitalized for AMI. Participants were stratified by AMI subtype (ST-segment\u2013elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and subsequently evaluated for sex-based differences in clinical presentation, functional impairments, management, and in-hospital complications. Among the study sample, women were slightly older than men (NSTEMI: 82.1 versus 81.3,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; STEMI: 82.2 versus 80.6,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and had lower rates of prior coronary disease. Women in the NSTEMI subgroup presented less frequently with chest pain as their primary symptom. Age-associated functional impairments at baseline were more common in women in both AMI subgroups (cognitive impairment, NSTEMI: 20.6% versus 14.3%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; STEMI: 20.6% versus 12.4%,\n              <jats:italic>P<\/jats:italic>\n              =0.001; activities of daily living disability, NSTEMI: 19.7% versus 11.4%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; STEMI: 14.8% versus 6.4%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; impaired functional mobility, NSTEMI: 44.5% versus 30.7%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; STEMI: 39.4% versus 22.0%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Women with AMI had lower rates of obstructive coronary disease (NSTEMI:\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; STEMI:\n              <jats:italic>P<\/jats:italic>\n              =0.02), driven by lower rates of 3-vessel or left main disease than men (STEMI: 38.8% versus 58.7%; STEMI: 24.3% versus 32.1%), and underwent revascularization less commonly (NSTEMI: 55.6% versus 63.6%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001; STEMI: 87.3% versus 93.3%,\n              <jats:italic>P<\/jats:italic>\n              =0.01). Rates of bleeding were higher among women with STEMI (26.2% versus 15.6%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) but not NSTEMI (17.8% versus 15.7%,\n              <jats:italic>P<\/jats:italic>\n              =0.21). Women had a higher frequency of bleeding following percutaneous coronary intervention with both NSTEMI (11.0% versus 7.8%,\n              <jats:italic>P<\/jats:italic>\n              =0.04) and STEMI (22.6% versus 14.8%,\n              <jats:italic>P<\/jats:italic>\n              =0.02).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among older adults hospitalized with AMI, women had a higher prevalence of age-related functional impairments and, among the STEMI subgroup, a higher incidence of overall bleeding events, which was driven by higher rates of nonmajor bleeding events and bleeding following percutaneous coronary intervention. These differences may have important implications for in-hospital and posthospitalization needs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.119.005691","type":"journal-article","created":{"date-parts":[[2019,10,14]],"date-time":"2019-10-14T09:00:18Z","timestamp":1571043618000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Sex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction"],"prefix":"10.1161","volume":"12","author":[{"given":"Michael G.","family":"Nanna","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.G.N., K.P.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M.","family":"Hajduk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT."},{"name":"National Clinician Scholars Program, Department of Internal Medicine (H.M.K., S.I.C.), Yale School of Medicine, New Haven, CT."},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.)."},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrence E.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel P.","family":"Dreyer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Center for Outcomes Research and Evaluation (R.P.D., B.S.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen P.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.G.N., K.P.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Geda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sui","family":"Tsang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine K.","family":"Welty","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.W., D.K.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basmah","family":"Safdar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Center for Outcomes Research and Evaluation (R.P.D., B.S.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dharshan K.","family":"Lakshminarayan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.W., D.K.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarwat I.","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"National Clinician Scholars Program, Department of Internal Medicine (H.M.K., S.I.C.), Yale School of Medicine, New Haven, CT."},{"name":"Section of General Internal Medicine, Department of Internal Medicine (S.I.C.), Yale School of Medicine, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Dodson","sequence":"additional","affiliation":[{"name":"Leon H. 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