Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction

• Published in: Circulation (New York, N.Y.) Vol. 104; no. 25; pp. 3034 - 3038
• Main Authors: VAKILI, Babak A, KAPLAN, Robert C, BROWN, David L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 18.12.2001; American Heart Association, Inc
• Subjects: Age Factors; Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Chlorobenzenes; Cohort Studies; Coronary Angiography; Coronary heart disease; Female; Heart; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Registries - statistics & numerical data; Retrospective Studies; Sex Factors; Survival Rate; Time Factors; Human; Prognosis; Infarct; Acute; Mortality; Coronary artery; Sex; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Myocardial disease; Treatment; Primary; Myocardium; Comparative study
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/hc5001.101060

Morbidity and mortality after an acute myocardial infarction (AMI) has been reported to be higher in women than men. However, in some prior reports, women were not treated as aggressively as men, suggesting a treatment bias. We sought to determine whether sex influenced short-term outcomes in a cohort of AMI patients, all of whom underwent primary angioplasty. We conducted a retrospective cohort study of all patients undergoing primary angioplasty for a first AMI in New York State in 1995. A total of 1044 patients, 317 women and 727 men, were identified. Mean age was 59+/-12 years in men and 65+/-12 years in women (P<0.05). Women had a higher prevalence of hypertension (59% versus 44%, P<0.05), diabetes (19% versus 14%, P<0.05), and peripheral vascular or carotid disease (9.5% versus 5.5%, P<0.05) than men. Men were more likely to be treated earlier (within 6 hours) from the time of symptom onset than women (74% versus 63%, P<0.05). Women had a higher incidence of shock or hemodynamic instability than men (25% versus 17%, P<0.05). The unadjusted in-hospital mortality rate was 7.9% in women and 2.3% in men (P<0.05). After multivariate logistic regression analysis, women maintained a 2.3-fold higher risk of in-hospital death compared with their male counterparts (95% confidence interval [CI], 1.2 to 4.6, P=0.016). After correcting for age and baseline risk differences, women undergoing primary angioplasty for AMI have a significantly higher in-hospital mortality rate than men.