Mortality caused by acute myocardial infarction in Qatari women

Abstract

T he long held belief that coronary heart disease (CHD) in women has a more benign prognosis than in men has resulted in less aggressive diagnosis and management patterns. Contrary to this belief, CHD is the leading cause of death in white women aged 60 years or older in the USA and outnumbers the next 16 causes of death in women combined, including cancers. Furthermore, since 1980, death from CHD has declined dramatically in men in the western world but has increased in women. 1With the recent recognition of this problem, considerable interest has been focused on the study of sex based differences in the outcome of patients with acute myocardial infarction (AMI) in the western world. Several studies have compared the outcome of women and men with AMI, with conflicting data.2-5 The majority of these studies have been performed in western populations and so may not necessarily apply to other ethnic groups such as the Middle Eastern population. The aim of the present study was to determine the clinical characteristics and in-hospital mortality from AMI in Qatari women. METHODSThis study was based at Hamad General Hospital, Doha, Qatar, which is the only tertiary care centre in the country and so all patients with AMI are treated here. The Hamad General Hospital cardiology database was used for this study; this database comprises data collected from all patients admitted to the cardiology department at the hospital since January 1991. Data were collected from the clinical records by the patients' physicians at the time of the patients' hospital discharge according to predefined criteria for each data point. We focused our study only on Qatari patients because it is a stable population and avoids the bias in the fluctuation of the expatriate population in the country. The study was approved by the institution review board.With the described database, all patients presenting with AMI in the period between 1991 and 2001 were identified. Age, sex, risk factors including smoking, hypertension, hypercholesterolaemia, diabetes, pre-existing coronary heart disease, in-hospital mortality and morbidity, as well as acute medical care provided were analysed. Data are expressed as mean (SD). Student's t test was employed for comparison between the mean values of the two groups and x 2 analysis was performed to test for differences in proportions of categorical variables between two or more groups. Multivariate stepwise regression analysis was used to identify predictors of outcome. A probability value of p , 0.05 was considered significant. RESULTSDuring the 10 year period a total of 20 856 patients were admitted to the coronary care unit and cardiology wards. Of these, 1598 Qatari patients were admitted with AMI; 1147 were male and 451 were female. When compared to men, women were older (62.1 (11.5) years v 59.9 (12.6) years, p , 0.001) and were more likely to have diabetes (68.5% v 48.3%, p , 0.001), hypertension (54.8% v 30.9%, p , 0.001), and hyperlipidaemia (30.4% v 24.9%, p = 0.029), but were less likely to be smokers (0....

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