Abstract Background Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and non-ischemic myocardial injury (NIMI), corresponding to troponin elevation without overt ischemia, are emerging concepts which are suspected to be common in patients hospitalized. However, their respective frequencies, risk profiles and short term prognosis in current routine clinical practice of emergency unit remains to be investigated. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital emergency unit (n=82 543), patients with elevated troponin Ic (≥0.10μg/L) (n=4568) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes), or as NIMI without such signs. Patients with missing biological data on admission (n=112) or T1MI diagnosis (n=2467) were excluded. Results Among the 1989 patients included, 539 (27%) were classified as T2MI and 1450 (73%) as NIMI. When compared with patients with NIMI, T2MI had higher troponin levels (0.27 (0.14–0.71) vs 0.22 (0.13–0.54) μg/L, p=0.008, respectively). NIMI and T2MI had similar risk factors (age (84 (74–90) vs 84 (75–91) y, p=0.3), male sex (43 vs 48%, p=0.07), hypertension (67 vs 71%, p=0.133), diabetes (25 vs 25%, p=0.9), prior CAD (24 vs 26%, p=0.342), systemic inflammatory response syndrome (SIRS, 47 vs 49%, p=0.3), and systolic blood pressure (SBP) (130 (111–153) vs 132 (112–153) mmHg, p=0.545). Biological data on admission were also similar (hyperglycemia (glucose ≥11 mmol/L), 14 vs 13%, p=0.37, creatinine (96 (72–148) vs 94 (72–141) μmole/L, p=0.598), anemia (Hemoglobin rate ≤10g/dL, 13 vs 14%, p=0.5), C-reactive protein elevation (CRP ≥3 mg/L, 88 vs 89%, p=0.7)). Moreover, in-hospital mortality was high and similar for both groups (15 vs 18%, p=0.2). In multivariate analysis, age, troponin rate, SIRS, anemia, SBP, hyperglycemia, creatinine and CRP elevation were independent factors associated with hospital mortality, but not T2MI (vs NIMI) (OR: 0.88 (0.66–1.17)). Older age and hyperglycemia were specific covariates associated with increased risk of mortality in T2MI, but not in NIMI. Conclusions This large real-life study of non-T1MI inpatients with elevated troponins from emergency department shows that myocardial injury without necrosis and T2MI share the same risk factors, characterized by a high rate of infections and anemia and a high risk of hospital mortality. Acknowledgement/Funding University Hospital Center Dijon Bourgogne, France
Gender equity has become a major concern in many professional fields. The rate of women as authors has to be interpreted according to the rate of women in the related professions. In this perspective, studying nurses' population should be of particular interest since, worldwide, nurses are mostly women. Then, our aim was to study gender disparity in nurses' publications.We selected the three main journals dedicated to nurse publications: International Journal of Nursing Studies, Journal of Nursing Scholarship, and European Journal of Cardiovascular Nursing. We included 20 recent consecutive papers from each journal. For each paper, the number of authors, their gender, and rank were recorded. Primary endpoint: overall rate of women as authors. Secondary endpoints: rate of women as first, last, second, and third authors.Sixty papers including 322 authors were analysed. Overall rate of women authors: 74%. Overall rate of women as first author: 82%. Overall rate of women as last author: 72%. Overall rate of women as second and third authors: respectively, 80% and 70%.Almost three-quarters of the authors in these main scientific journals of nursing studies were female. This rate is lower than the gender rate in the nursing profession.
Introduction: Cardiac arrest outside hospital (CAOH) is a real public health problem as it causes 50,000 deaths per year in France. It is therefore crucial to identify prognostic factors for death due to CAOH, other than time to initial management. In the acute phase of myocardial infarction (MI), admission hyperglycemia has been shown to be a major prognostic factor for in-hospital complications. The aim of our study using data from the Observatoie des infarctus du myocarde de Côte-d'Or (RICO) was to investigate the impact of admission glycemia on in-hospital death in these patients following CAOH during MI. Patients and methods: We included all patients with CAOH during MI and transferred to the CHU for a coronary angiogram between 1st July 2006 and 31st January 2012, recorded in the RICO database. Prognostic factors for in-hospital death were studied using a multivariable logistic regression model. Results: Of the 100 patients included, mean age 63 years, the majority were men (81%). Patients who died (57%) were characterized by older age, higher admission glycemia, more severely impaired LVEF and a greater likelihood of the CAOH occurring at home than those who did not die during the in-hospital phase. However, other risk factors, times to treatment and characteristics of the MI were similar in the two groups. In multivariable analysis, admission glycemia was a powerful independent predictor of death (OR: 1.14 [95% CI: 1.05-1.26]; p=0.003) beyond age (OR: 1.06 [95% CI: 1.02-1.11]; p=0.003), and the CAOH occurring at home (OR: 7.97 [95% CI: 0.82-77.45]; p=0.074). The prognostic value of admission hyperglycemia was optimal for a threshold glycemia of 11 mmol/L and was independent of the presence of diabetes. Conclusion: Our results suggest the interest of evaluating glycemia early on because of its prognostic value in a context of CAOH during MI, and underline the need for further studies to evaluate the interest of early medical treatment to control glycemia, whether the patient has diabetes or not.
Editor, The gender gap is a major concern in many fields of professional activity, including sciences and medicine.1,2 In France, girls makes up the majority of students at university, and women have a higher success rate than men at undergraduate level. Women have a higher success rate than men at undergraduate level.3 In contrast, only 15 to 20% of university professors of medicine (highest level) are women.3 Similar proportions are observed for chiefs of staff or heads of departments in France. Even though there are disparities between scientific fields, or even between medical or surgical specialities, there are also wide international disparities. For example, in Iceland and Portugal, more than 60% of PhDs are women whereas the average in the Organisation for Economic Co-operation and Development (OECD) countries is 46% (43% in France).3 In the specific field of anaesthesiology, the proportion of women anaesthesiologists remains low: 35% in 2010 and rising to 37% in 2018.4 Several studies have shown that gender inequalities are present in medical scientific publications; however, no study has ever investigated gender inequalities in publications in anaesthesiology in France. We studied articles published in Anesthesia, Critical Care and Pain Medicine (ACCPM), the official journal of the French Society of Anesthesia and Intensive Care that has a quarter of the specialty's physicians as active members. Summaries of each issue were reviewed from February 2015 (first issue) to June 2019. Original articles were selected. For each of these articles, we recorded the year of publication, the number of authors and the declared gender and the rank of each author. We excluded articles when first or last authors belonged to a non-French team. When the first name was not provided or indeterminate, the author's gender was searched among the available affiliation information or through direct contact (authors or institution). Our primary endpoint was the proportion of female authors as the first or last author. Our secondary endpoints were the overall proportion of female authors, their frequency as second or third author and their frequency in significant rank (first, second, third and last author). To study the evolution of our primary end-point over time, we analysed the three chronological terciles of published articles. Comparisons were performed using χ2-tests. Finally, in order to exclude selection bias, we counted female authors as total, first or last authors in French teams' publications in convenience samples including the last 30 consecutive articles in two other main journals of anaesthesiology, the European Journal of Anaesthesiology (December 2018 to February 2020) and Anesthesiology (January 2019 to February 2020). Twenty-six volumes of ACCPM were studied, including 273 articles. Thirty-one (11%) articles were excluded as the first or last author belonged to a non-French team. Finally, 242 (89%) articles including 1890 authors were analysed and 461 (24%) of these authors were women. The incidence of women as first or last author was 21% (28% as first author and 13% as last author, P = 0.01). Results are shown in Table 1. The incidence of females as first or last authors was 23% during the first tercile (February 2015 to August 2016), 22% during the second tercile (October 2016 to February 2018) and 20% during the third tercile (April 2018 to August 2019) (P = 0.9). The proportions of female authors in the European Journal of Anaesthesiology and Anesthesiology were, respectively, 25% (56/227) and 28% (45/162), not different from ACCPM (P = 0.7). The number of females as first or last authors in the European Journal of Anaesthesiology and Anesthesiology were, respectively, 13% (4/30) and 30% (9/30) (first author) and 1% (3/30) and 15% (4/26) (last author), not different from ACCPM (P = 0.2 and 0.3) (Table 2). Table 1 - Gender and author's ranking distribution in published articles by French anaesthesiologists in Anesthesia, Critical Care and Pain Medicine (ACCPM) from February 2015 to June 2019 Total authors First author Last author Second author Third author Other position Female 461/1890 (24%) 68/242 (28%) 32/242 (13%) 82/242 (34%) 77/242 (32%) 202/922 (22%) Male 1429/1890 (76%) 174/242 (72%) 210/242 (87%) 160/242 (62%) 165/242 (68%) 720/922 (78%) Total 1890a (100%) 242b (100%) 242b (100%) 242b (100%) 242b (100%) 922c (100%) P – 0.2 0.0001 0.0002 0.004 0.01 Values are ratio (%).aTotal of all authors regardless of their gender in all published articles.bTotal of all articles with at least four authors.cTotal of all authors regardless of their gender other than first, second, third or last author. Table 2 - Gender and author's ranking distribution of French anesthesiologists in the 30 last and consecutive articles published by Anesthesiology (from January 2019 to February 2020) and European Journal of Anaesthesiology (from December 2018 to February 2020) Total of female authors Female as first author Female as last author Anesthesiology 45/162 (28) 9/30 (30) 4/26a (15) European Journal of Anaesthesiology 56/227 (25) 4/30 (13) 3/30 (10) P ∗ 0.7 0.2 0.3 Values are ratio (%).∗P-value calculated when comparing results of each journal to ACCPM results.aOut of 26 articles with at least four authors. The frequency of female authors was low in ACCPM, amounting to 24% of all authors. Moreover, it was lower regarding the significant ranks, such as first or last authors (21%). Women are clearly under-represented in authorship in French anaesthesiology articles. Furthermore, our results cannot be explained by a hypothetical voluntary choice of French female authors to publish consistently in journals other than the French ACCPM Journal. Of note, because last authors are usually full professors and first authors are more often juniors, we hope that in 15 years from now there will be more women as full professors signing as last authors on scientific publications. The rate of publications with a woman as first or last author was close to 25% in Science and reached one-third in The Lancet Infectious Diseases.2,5 In contrast, in psychiatry, women as first authors reached 44% in 2018.6 Actions have to be taken to close the gender gap at least in scientific production in the field of French anaesthesiology. Nevertheless, our results have to take into consideration the proportion of women within each specialty. The proportion of women anaesthesiologists in France was 37% in 2018. Therefore, this can explain the quite low global rate for women in publications but does not explain why they were under-represented in significant ranks. Thus, efforts should be made to better understand the early determinants of women's participation in research in medicine, and especially in anaesthesiology. As for other fields with fewer female students, some of those determinants could be linked to social and environmental factors, such as negative stereotypes, gender bias or residual inequities in family responsibilities.7 However, beyond those social prevalent factors, the climate of academic research and persisting conservative institutions can also widen the gender gap. Rosso et al.7 investigated the personal experience of academic physicians: women were under-represented in academic positions among intensivists and anaesthesiologists and they reported prejudices during the academic selection and promotion processes. However, there were no gender differences in scientific production. Thus, it is likely that the impediment to female student investment in scientific research has settled upstream during medical studies. The authors suggest implementing changes in the undergraduate curriculum. Setting up leadership workshops and mentorship could also be an interesting solution to empower female students, helping them to gain self-confidence so as to embrace academic careers. Similar investigations should be undertaken in other countries and specialities. The gender gap still exists in medical research; even if several cracks have appeared in the glass ceiling, there is still much to be done so as not to lose further talent.
Abstract Background Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin. Methods Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes). Results Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract (n=111), urinary tract (n=27), skin (n=15), digestive tract (n=9) or other or indefinite site (n=23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, p=0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality. Conclusions Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.
A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our study assessed the incidence and characteristics of T2MI compared to type 1 (T1MI) in CAD patients admitted to an ED. Among 33,669 consecutive patients admitted to the ED, 2830 patients with T1MI or T2MI were systematically included after prospective adjudication by the attending clinician according to the universal definition. Among them, 619 (22%) patients had a history of CAD. Using multivariable analysis, CAD history was found to be an independent predictive factor of T2MI versus T1MI (odds ratio (95% confidence interval) = 1.38 (1.08-1.77),
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