Cardiology Letters 2011, 20(4):292-300

Gender differences and early mortality in acute myocardial infarction.

Tomasek A¹, Janousek S², Nemec P¹, Adamkova R²

¹ Centre of Cardiovascular and Transplantation Surgery, Brno

² Department of Cardiology in Brno, Czech Republic

Introduction: Coronary artery disease (CAD) is the leading cause of cardiovascular mortality in European countries. Despite a lower incidence of acute myocardial infarction (AMI), its mortality is higher in women than in men. The reasons for this phenomenon have been widely discussed in literature.

Aims: To analyse the clinical course, treatment, complications and early (in-hospital) mortality of AMI patients with the focus on identification of sex differences and analysis of their causes. The key question is whether gender is an independent risk factor of mortality in AMI. Methods and study group: The retrospective analysis of 889 consecutive patients hospitalized with AMI at the Coronary Care Unit of the Brno University Hospital within the period January 2003 to December 2004. The hospital data were studied from medical records and the mortality data were checked from population and insurance registries.

Results: In our study group there was a significant predominance of men (n = 573, 64.5%). Compared to men, in women we found: a higher average age (71 ± 10 vs. 64 ± 12 years), a higher incidence of diabetes and hypertension (36.7% vs. 25.0%, resp. 68.0% vs. 51.1%), more frequently right ventricle ischemia (17.4% vs. 10.5%) and higher complication rates: on admission more common atrial fibrillation (8.5% vs. 4.2%) and heart failure (41.1% vs. 32.9%), during hospitalization a higher incidence of circulatory failure resulting into resuscitation (12.6% vs. 6.9%), artificial ventilation (15.5% vs. 7.8%) or temporary pacing (14.6% vs. 9.4%). In women with STEMI mechanical complications were seen more frequently - especially left ventricle free wall rupture (2.8% vs. 1.0%) and ischemic strokes (3.1% vs. 0.0%). In-hospital mortality was higher in women (13.9% vs. 9.6%). As its strongest predictors were identified: complications (HR 15.0, CI 6.3 - 35.7), poor left ventricle ejection fraction (HR 1.05, CI 1. 02 - 1.08) and age (HR 1.06, CI 1.1 - 1.10). In contrast, no gender differences were observed in the extent of interventional, surgical or pharmacological treatment and in the extent of left ventricle systolic dysfunction. Gender was not identified as an independent predictor of in-hospital mortality.

Conclusion: In our analysis women suffered heart attack at a significantly higher age and a severe comorbidity status. Despite treatment comparable to men, AMI was associated with higher rates of complications in women. Their in-hospital mortality was higher in comparison to men. As the main predictors of in-hospital mortality after AMI identified were: complications, left ventricle ejection fraction and age. Gender was not confirmed as an independent risk predictor of in-hospital mortality in patients with AMI.

Keywords: coronary artery disease; acute myocardial infarction; STEMI; gender

Published: April 1, 2011  Show citation