Younger age potentiates post myocardial infarction survival disadvantage of women

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Abstract

Background

Female patients with acute myocardial infarction (MI) exhibit higher unadjusted in-hospital mortality rates compared to male patients. However, contradictory evidence exists on whether this survival disadvantage disappears after adjustment for age and other prognostic factors. This study, based on a countrywide survey of consecutive unselected patients with acute MI, examined whether female gender is an independent predictor of poor short-term outcome and less intensive in-hospital treatment.

Methods

Data on a total of 7433 patients were analyzed.

Results

The mean age was 64 ± 13 years and the proportion of females in this population was 23%. Univariate and multivariate predictors of in-hospital mortality in female patients were estimated. Unadjusted in-hospital mortality rates of women were significantly higher compared to men (17.7 vs. 8.6, p < 0.001). In multivariate analysis, female gender was an independent predictor of in-hospital mortality in the total population [relative risk (RR) = 1.29, 95% confidence interval (CI) = 1.02–1.64, p = 0.036]. The RR of women for in-hospital death was exaggerated among younger patients, aged < 55 years (RR = 3.84, 95% CI = 1.07–13.74, p = 0.039). Female gender was also independently and inversely associated with administration of thrombolytic treatment (RR = 0.724, 95% CI = 0.630–0.831, p = <0.001).

Conclusion

Although female gender is an independent predictor of higher post-MI in-hospital mortality with a pronounced effect among younger patients, women are less likely to receive thrombolysis than men. Based on the results from this countrywide study, we should consider women, especially of younger age, as patients at particular high risk, who contrary to common practice, deserve more intensive and aggressive in-hospital treatment.

Introduction

Despite recently developed preventive strategies as well as advances in treatment, the burden of cardiovascular disease among women remains high. In contrast to the traditional notion that coronary events are uncommon in this population, cardiovascular disease deaths among women have exceeded those among men [1]. Although there is general agreement that women exhibit higher unadjusted mortality rates after acute MI [2], [3], [4], conflicting evidence exist concerning the female-to-male relative risks after adjustment for age, diabetes mellitus, hypertension and other prognostic factors [2], [5]. Recent studies, trying to obtain further insight on the issue, have also demonstrated a varying effect of gender on post-MI short-term prognosis in relation to age [6], [7].

The present study is a secondary analysis of the Hellenic multicenter study for acute MI, which aimed to estimate the incidence of acute MI in the Greek population and to evaluate the in-hospital mortality of consecutively hospitalized patients with acute MI, on a countrywide basis. The study patients were derived from a relatively low coronary risk, homogeneous, in terms of ethnic and cultural background, population [8].

Section snippets

Patient population

This study aimed to record the total of patients hospitalized for AMI on a countrywide basis, in order to estimate the incidence and management of the disease in the Greek population. Patients were enrolled if they were admitted in the hospital within 24 h from the onset of symptoms. The diagnosis was established on the basis of the presence of typical pain lasting at least for 30 min, temporal rise and fall of serially obtained values of serum levels of cardiac enzymes and dynamic

Baseline characteristics and in-hospital mortality rates

The main baseline characteristics of the study population in relation to gender are presented in Table 1. Unadjusted in-hospital mortality rates of female patients were significantly higher compared to male patients (17.7 vs. 8.6, p < 0.001). Based on univariate analysis, female gender [relative risk (RR) = 2.05, 95% confidence interval (CI) = 1.94–2.66, p < 0.001], older age (RR = 1.08, 95% CI = 1.07–1.09, p < 0.001), smoking status (RR = 2.14, 95% CI = 1.77–2.58, p < 0.001), hypertension (RR = 1.52, 95% CI = 

Discussion

This study, based on a countrywide survey of consecutive unselected patients, demonstrated that female gender was an independent predictor of poor short-term outcome following acute MI. Moreover, the adverse effect of gender on early post infarction outcome was exaggerated among younger women. In addition, despite their worse early prognosis, women were less likely to receive a vigorous in-hospital treatment.

Acknowledgements

The Hellenic Study of Acute Myocardial Infarction was supported and supervised by the Hellenic Cardiological Society and was also supported by Servier Hellas S.A. The authors are indebted to all the cardiologists and to all the directors of the Cardiac departments who participated in the study. The complete list of study investigators and coordinators, and the list of the 76 hospitals that have participated in this study, has been published previously [9].

References (19)

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