Gender differences in the management and outcome of acute myocardial infarction in unselected patients in the thrombolytic era

doi:10.1016/S0002-9149(99)00902-9

The American Journal of Cardiology

Volume 85, Issue 8, 15 April 2000, Pages 921-926

https://doi.org/10.1016/S0002-9149(99)00902-9 Get rights and content

Abstract

This study compares the clinical features, management, and outcome in men and women from a consecutive, unselected series of patients with acute myocardial infarction (AMI) who were admitted to a university cardiac center over a 3-year period. It is a retrospective observational study of 1,059 admissions with AMI identified through the Hospital In-Patient Enquiry (HIPE) registry, validated according to Minnesota Manual criteria, and followed for a period of up to 5 years (median 36 months). Women comprised 40% of all admissions, had a higher hospital mortality (24% vs 16%, p <0.001), and were less likely to receive thrombolysis (23% vs 33%, p <0.01), admission to coronary care (65% vs 77%, p <0.001), or subsequent invasive or noninvasive investigations (55% vs 63%, p <0.01). However, women with AMI were older than men with AMI (71 vs 65 years, p <0.001). After adjusting for age, differences that remained significant were prevalence of hypertension (odds ratio [OR] 2.12, 95% confidence intervals [CI] 1.56 to 2.88) and cigarette smoking (OR 0.47, 95% CI 0.35 to 0.65), management in coronary care (OR 0.66, 95% CI 0.49 to 0.88), and hospital mortality (OR 1.48, 95% CI 1.07 to 2.04). Excess mortality occurred predominantly in women <65 years old (18% vs 8%, OR [multivariate] 2.35, 95% CI 1.19 to 4.56), among whom multivariate analysis demonstrated a significantly lower thrombolysis rate (OR 0.48, 95% CI 0.27 to 0.86). In this group, lack of thrombolysis independently predicted hospital mortality (OR 5.37, 95% CI 1.45 to 19.82). Female gender was not an independent predictor of mortality following AMI (OR 1.42, 95% CI 0.90 to 2.26). Thus, among unselected patients, female gender is associated with, but not an independent predictor of, reduced survival after AMI. Gender differences in mortality are greatest in younger patients, who are less likely to receive thrombolysis and in whom lack of thrombolysis is independently associated with mortality after AMI.

Section snippets

Patients

Methods of patient ascertainment and data collection for this historical cohort study of unselected, consecutive patients with AMI who were admitted to 1 center during the thrombolytic era have been described in detail elsewhere.17 Briefly, all patients admitted to a university cardiac center between June 1992 and December 1994 with primary or secondary diagnosis of AMI were identified for inclusion using the Hospital In-Patient Enquiry (HIPE) database, which includes demographic, diagnostic,

Results

TABLE I, TABLE II, TABLE IIIdelineate gender differences in demographic and risk factor profiles, site and complications of AMI, and management, respectively. Of 1,059 patients, 397 were women (40%). Mean age was 70.9 (±12.9) years versus 64.7 (±13) years in men (p <0.001). There were no gender differences regarding the site of AMI. When unadjusted for age, women were less likely to have a history of cigarette smoking, more likely to be hypertensive (Table I), had a higher hospital mortality

Discussion

This study of unselected, consecutive patients with AMI demonstrates a significantly higher hospital mortality rate and a higher rate of nonfatal complications among women. This is associated with gender differences in demographics, risk factor profiles, and (in subgroups) management strategies.

Acknowledgements

We gratefully acknowledge the assistance of Sister Bernadette Egan and Sister Anna Hennessey in the completion of this study, and Mark M. Gallagher, MD, for critically reviewing the manuscript.

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Gender differences in the management and outcome of acute myocardial infarction in unselected patients in the thrombolytic era

Abstract

Section snippets

Patients

Results

Discussion

Acknowledgements

Am J Cardiol

Am Heart J

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Metabolism

In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Comparison with 4,315 men

Circulation

Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. GUSTO-I investigators

JAMA

Sex differences in mortality after myocardial infarction. Is there evidence for an increased risk for women?

Circulation

A communitywide perspective of sex differences and temporal trends in the incidence and survival rates after acute myocardial infarction and out-of-hospital deaths caused by coronary heart disease

Circulation

Gender differences in the treatment of patients with acute myocardial infarction. A multihospital, community-based perspective

Arch Intern Med