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

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Abstract

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.

Section snippets

The MITRA registry:

The Maximal Individual TheRapy of Acute myocardial infarction (MITRA) is a prospective German multicenter registry investigating the current treatment of acute myocardial infarction. The 54 participating hospitals are located in the Southwest of Germany. This region is representative of the rest of Germany. Almost all hospitals within a defined area participated, so that almost all patients with myocardial infarction within this area were registered. The study centers included university

Baseline characteristics:

Between June 15, 1994, and January 31, 1997, a total of 6,066 consecutive patients with STEMI were admitted to 54 participating hospitals. One third of all patients were women, 2/3 were men. Women were 9 years older than men (mean age 71 vs 62 years). Women had a history of prior myocardial infarction less often, but had a history of hypertension and diabetes mellitus more often (Table 1).

Presenting symptoms and signs:

With a prehospital delay of 195 minutes, women with STEMI reached the hospital 45 minutes later than men

Patient characteristics:

In accordance with previous studies,2, 3, 11, 12, 13 our study shows that women and men are different in their risk profiles: women were older by an average of 9 years, had a higher incidence of systemic hypertension, diabetes mellitus,2, 3, 14 and congestive heart failure, but were less likely to have a history of myocardial infarction. Women presented later (45 minutes) in the course of their infarction,3, 15, 16, 17 had a higher heart rate on admission, and more often had anterior wall

Acknowledgements

We would like to thank Horst Dehn for his assistance in organization of the study, and Hannelore Heine and Roland Krämmer for their assistance in data management.

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    This study was supported in part by Astra-Zeneca GmbH, Plankstadt; Bristol Myers Squibb, Munich; Knoll AG, Ludwigshafen; and Landesversicherungsanstalt, Rheinland Pfalz, Germany.

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