Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry)

• Published in: The American journal of cardiology Vol. 89; no. 5; pp. 511 - 517
• Main Authors: Heer, Tobias, Schiele, Rudolf, Schneider, Steffen, Gitt, Anselm K, Wienbergen, Harm, Gottwik, Martin, Gieseler, Ulf, Voigtländer, Thomas, Hauptmann, Karl E, Wagner, Stefan, Senges, Jochen
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2002; Elsevier; Elsevier Limited
• Subjects: Aged; Angina Pectoris - drug therapy; Angina Pectoris - mortality; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Emergency Medical Services - statistics & numerical data; Female; Gender; Germany; Heart; Heart attacks; Heart Failure - drug therapy; Heart Failure - mortality; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Prospective Studies; Registries; Sex Factors; Survival Analysis; Thrombolytic Therapy - statistics & numerical data; Germany; Human; Prognosis; Infarct; Acute; Coronary artery; Sex; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Myocardial disease; Survival; Percutaneous route; Chemotherapy; Treatment; Follow up study; Myocardium; Comparative study; Fibrinolytic
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(01)02289-5

There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-adjusted OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart failure more often during their hospital stay. The age-adjusted long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women.