2 research outputs found
Sex Disparities In St-Elevation Myocardial Infarction Care And Outcomes: A Global Systematic Metaanalysis
Background: Cardiovascular disease is the leading cause of death worldwide. Outcomes of patients with ST-segment–elevation myocardial infarction (STEMI) have improved through widespread implementation of systems-of-care, yet sex disparities continue to be reported. A comprehensive, global study of sex disparities in contemporary STEMI care and outcomes has not been undertaken.
Objective: To examine whether sex differences in STEMI management and mortality outcomes persist worldwide and by geographic region.
Methods: A systematic PubMed literature search was performed using search terms “sex” or “gender” and “STEMI” for studies in English from 2000 to present reporting sex-based STEMI mortality. Articles with primary data on sex-based STEMI mortality were included. Data collected prior to 2000, sub-categorized data, and studies with less than 50 women were excluded. Meta-analyses were conducted using random effects models and are reported overall and by geographic region. Heterogeneity was assessed via Cochran’s Q statistic. Sex differences were evaluated in baseline characteristics, door-to-balloon times, and mortality (in-hospital, 30-day, 6 months, and 1 year).
Main Outcome and Measure: The primary outcome is in-hospital to 12-month mortality. Secondary outcome is Door-to-Balloon/Door-to-Reperfusion time.
Results: 613 published manuscripts were reviewed and ultimately 75 studies included in the meta-analysis, representing 29 countries in 6 geographic regions and 731,990 patients (32% female). Women were older and had more diabetes and hypertension. Overall, unadjusted in-hospital mortality was 2-fold higher in women compared to men (2.09 OR, 95%CI 1.91-2.08; p
Conclusions: This study demonstrates concerning global sex disparities in risk factors, time to treatment, STEMI care and a doubling of unadjusted mortality in women. Adjustments for comorbidities suggest that modifiable risk factors, rather than difference in reperfusion therapy, account primarily for the difference in mortality. This highlights the need for a global call-to-action to elucidate critical factors and barriers to preventive care to reduce the observed sex gap in STEMI outcomes worldwide
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The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals
Pancreatic adenocarcinoma (PC) is a highly lethal malignancy with a survival rate of only 12%. Surveillance is recommended for high-risk individuals (HRIs), but it is not widely adopted. To address this unmet clinical need and drive early diagnosis research, we established the Pancreatic Cancer Early Detection (PRECEDE) Consortium.
PRECEDE is a multi-institutional international collaboration that has undertaken an observational prospective cohort study. Individuals (aged 18-90 years) are enrolled into 1 of 7 cohorts based on family history and pathogenic germline variant (PGV) status. From April 1, 2020, to November 21, 2022, a total of 3,402 participants were enrolled in 1 of 7 study cohorts, with 1,759 (51.7%) meeting criteria for the highest-risk cohort (Cohort 1). Cohort 1 HRIs underwent germline testing and pancreas imaging by MRI/MR-cholangiopancreatography or endoscopic ultrasound.
A total of 1,400 participants in Cohort 1 (79.6%) had completed baseline imaging and were subclassified into 3 groups based on familial PC (FPC; n=670), a PGV and FPC (PGV+/FPC+; n=115), and a PGV with a pedigree that does not meet FPC criteria (PGV+/FPC-; n=615). One HRI was diagnosed with stage IIB PC on study entry, and 35.1% of HRIs harbored pancreatic cysts. Increasing age (odds ratio, 1.05; P<.001) and FPC group assignment (odds ratio, 1.57; P<.001; relative to PGV+/FPC-) were independent predictors of harboring a pancreatic cyst.
PRECEDE provides infrastructure support to increase access to clinical surveillance for HRIs worldwide, while aiming to drive early PC detection advancements through longitudinal standardized clinical data, imaging, and biospecimen captures. Increased cyst prevalence in HRIs with FPC suggests that FPC may infer distinct biological processes. To enable the development of PC surveillance approaches better tailored to risk category, we recommend adoption of subclassification of HRIs into FPC, PGV+/FPC+, and PGV+/FPC- risk groups by surveillance protocols