Increased Cardiac Mortality in Women Compared with Men in Patients with Acute Myocardial Infarction

Abstract

Objective It has been reported that women with acute myocardial infarction (AMI) have a higher short-term mortality rate than men, but the reason is not known. The profile in relation to age, gender and risk factors was evaluated to compare AMI and unstable angina pectoris (UAP).Methods Findings from 984 patients including 580 patients with AMI (129 women, 451 men) and 404 patients with UAP (131 women, 273 men) were analyzed by the South Osaka Acute Coronary Syndrome Study Group (SACS). The primary endpoint of the study was in-hospital death. The primary endpoints of interest (cardiac death) were fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death.Results Cardiac death during hospitalization within 30 days in AMI was higher in women than in men (12.4% vs 6.7%, p<0.05). On the other hand, in UAP there was no significant difference between women and men (1.5% vs 0.7%, NS). The incidence of cardiac death in AMI was significantly higher for patients 75 years old and older (19.0%) than for patients less than 55 years old (4.2%), 55-64 years old (3.5%) and 65-74 years old (4.7%) (p<0.001, respectively).Conclusions Cardiac death was higher for women compared with men in patients with AMI. The worse prognosis for the AMI women patients was likely to be derived from less performance of percutaneous coronary intervention, and a high incidence of severe myocardial infarction. Further research should be focused on the analysis of various clinical backgrounds.

Sex Differences in Myocardial Infarction Events Between Patients With and Without Conventional Risk Factors: The Modares Heart Study

“…In women, however, this pattern was not followed for all of the traditional risk factors. 11 Male ratio in MI for our study was lower than that reported by Kanamasa and colleagues, 8 but the downward trend in sex ratios between age groups was similar in Kanamasa and associates' study.…”

“…7 On the other hand, the women were older than men with MI, but the prevalence of DM and HTN was not different between the 2 sexes. 8 In another study, the prevalence of HTN and self-reported diabetes was very similar in men and women. Only 37% of the men exhibited none of the 3 risk factors, 39% exhibited 1 risk factor, and 24% had ≥2 risk factors.…”

“…While some authors have reported differences in risk factor profiles between men and women, [5][6][7] others have been unable to reach such conclusions. 8,9 A substantial part of the risk associated with ethnicity can be attributed to socioeconomic status and geographic location, although geographic areas may vary substantially in risk for CHD. 10 Little information is available in relation to distribution of risk factors between the 2 sexes in our geographic zone.…”

Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

“…Comparison of use ofâ-blockers showed it was underused in females (63%) compared to males (75%) which is statistically significant (p=0.046).This finding is consistent with previous reports. 9,10,[12][13][14][15] The significant underuse of â-blockers in female patients in our study may be explained by the fact that more females had diabetes mellitus and congestive heart failure. International data support the fact that despite recommendations in favour of use of â-blockers, these are still underused in post-infarct patients, at the expense of many lives lost 17 .…”

“…Similar results were also reported by others. 9,10,12 Regarding treatment with reperfusion, in our series, we used Streptokinase for reperfusion therapy within 12 hours of symptom onset in cases of eligible STEMI patients. Streptokinase was significantly underused in females (15.6%) compared to males (32.2%) (p=0.011).Underuse of reperfusion therapy was also reported in other studies.…”