Coronary artery disease
Gender–Age Interaction in Early Mortality Following Primary Angioplasty for Acute Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2006.06.012Get rights and content

Previous studies have demonstrated a significant interaction between gender and age after medically treated acute myocardial infarction (AMI), when younger women were found to have a higher mortality rate than younger men, but the mortality rate for older men and women was similar. The study objective was to determine whether a gender–age interaction exists for AMI treated exclusively with primary angioplasty. This analysis was a retrospective cohort study of 9,015 consecutive patients who underwent primary angioplasty for AMI in New York State from 1997 to 1999. The primary end point of interest was in-hospital mortality. A logistic regression model was constructed to determine the relation between gender and mortality among patients with AMI treated with angioplasty. Additional analyses were performed to test whether a mortality difference existed according to age. In-hospital mortality rate was twofold higher in women than in men (6.7% vs 3.4%, p <0.001). After adjusting for age, co-morbid conditions, and hemodynamic status by multivariable logistic regression analysis, the odds ratio for in-hospital death for women was no longer significant (odds ratio 1.21, 95% confidence interval 0.69 to 2.10, p = 0.51). Among patients <75 years of age, women had a 37% increased risk of in-hospital mortality (adjusted odds ratio 1.37, 95% confidence interval 1.01 to 1.98, p = 0.04), whereas there was no significant difference in mortality between men and women who were ≥75 years of age. In conclusion, female gender was found to be an independent predictor of in-hospital mortality in patients <75 years of age after primary angioplasty for AMI.

Section snippets

Methods

The study population consisted of 9,015 consecutive patients who underwent primary angioplasty for AMI in New York State between January 1, 1997 and December 31, 1999. Patients were included in the analysis if they underwent attempted angioplasty for AMI within 23 hours of symptom onset. This definition of primary angioplasty is consistent with that used by the Society of Cardiac Angiography and Interventions.5

Prospectively defined data elements including demographics, co-morbidities,

Results

In total, 9,015 patients with AMI were treated with primary angioplasty, of whom 2,619 (29%) were women. Table 1 lists the baseline characteristics of women and men in this analysis. Women were older (66 vs 59 years, p <0.001) and had a higher prevalence of hypertension (64% vs 52%, p <0.001), diabetes (23% vs 15%, p <0.001), and peripheral vascular disease (8% vs 5% p <0.001) than men. Race and body mass index did not differ between genders. Women were less likely to have a history of MI (43%

Discussion

Two significant findings emerge from this study. First, in this cohort of unselected patients treated with primary angioplasty for AMI, women had increased unadjusted in-hospital mortality compared with men that was no longer significant after adjustment for demographics, co-morbidities, and clinical presentation. Second, when examining the interaction of gender with age, our study demonstrated a marked difference in outcome after AMI for women versus men when stratified by age. Among patients

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The views presented are those of the authors and may not reflect those of the New York State Department of Health or the Cardiac Advisory Committee.

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