Impact of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction patients in Thailand.

BACKGROUND: Coronary heart disease is the leading cause of mortality and morbidity in men as well as in women. Women have their first cardiac event 6 to 10 years later than men do. Whereas, the cardiovascular death rates are declining in men, they remain constant in women. In cardiovascular studies with age limits, women are naturally the minority, amounting to < 40%.
OBJECTIVE: Determine the effect of gender on treatment and clinical outcomes in acute ST elevation myocardial infarction (STEMI) patients. MATERIAL AND
METHOD: This is a multicenter study including 13 government and 4 private institutions. Between August 1, 2002 and October 31, 2005, 3,836 consecutive patients with ST elevation myocardial infarction were enrolled. The patient characteristics, treatment, and hospital outcome were collected and validated. In-hospital management and outcomes were compared between men and women, without adjustment, with adjustment for age alone and with adjustment for age and other covariates by means of multivariate stepwise logistic regression analysis. In each model tested, gender was forced into the model, whereas other predictors were selected in a stepwise manner
RESULTS: Women were 1,223 patients (31.9%) of all patients and were 8 years older than men (67.5 +/- 12.0 vs. 59.7 +/- 12.4 years). Women had a higher incidence of diabetes and hypertension (46.9% vs. 31.0%, p < 0.001 and 62.1% vs. 45.3%, p < 0.001). Smoking and family risk factor were found in men more than in women (17.5% vs. 52.5%, p < 0.001 and 7.4% vs. 11.2%, p< 0.001). Women presented more frequently with cardiac dyspnea and shock than men (35.3% vs. 22.2%, p < 0.001 and 21.5% vs. 13.8%, p < 0.001). There was no difference in time to admission between men and women. Beta blocker, statin, angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor inhibitor (ARB) were less frequently used in women. Coronary angiogram was performed less often in women and less abnormal angiogram were found (57.8% vs. 65.0%, p < 0.001 and 55.5% vs. 63.9%, p < 0.001). A lower percentage of women received thrombolytic therapy (28.1% vs. 31.4%, p = 0.039) as well as percutaneous coronary intervention (PCI) (39.0% vs. 48.5%, p < 0.001).Unadjusted in-hospital mortality was significantly higher in women than in men (23.6% vs. 13.9%, unadjusted OR (95% CI) 1.90 (1.60-2.26), p < 0.001). After adjustment of other covariables (age group> 75 years, hospital group (metropolitan, regional), chest pain, cardiac dyspnea, shock, post cardiac arrest, diabetes, hypertension, family history, smoking, dyslipidemia, refer time to admission < or = 12 hours (hour), aspirin, beta blocker calcium antagonist, statin, ACEI, ARB, nitrate, coronary angiogram, thrombolysis, PCI, coronary artery bypass grafting, congestive heart failure, arrhythmia, stroke, bleeding), the gender difference in-hospital mortality no longer existed (adjusted OR (95% CI) 1.03 (0.80-1.33), p = 0.814). The incidence of congestive heart failure as a complication was significantly higher in women than in men (55.6% vs. 38.7%, p < 0.001, adjusted OR (95% CI) 1.29 (1.08-1.54), p = 0.005).
CONCLUSION: Women with acute ST elevation myocardial infarction were older and had a higher incidence of hypertension and diabetes than men. Women were less likely than men to undergo coronary angioplasty. Women in the authors' registry had a higher risk for in-hospital morbidity and mortality than men. Early and aggressive treatment might improve the clinical outcomes in women with STEMI.