Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction

Babak A. Vakili, Robert C. Kaplan, David L. Brown

Research output: Contribution to journalArticle

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Abstract

Background - Morbidity and mortality after an acute myocardial infarction (AMI) has been reported to be higher in women than men. However, in some prior reports, women were not treated as aggressively as men, suggesting a treatment bias. We sought to determine whether sex influenced short-term outcomes in a cohort of AMI patients, all of whom underwent primary angioplasty. Methods and Results - We conducted a retrospective cohort study of all patients undergoing primary angioplasty for a first AMI in New York State in 1995. A total of 1044 patients, 317 women and 727 men, were identified. Mean age was 59±12 years in men and 65±12 years in women (P<0.05). Women had a higher prevalence of hypertension (59% versus 44%, P<0.05), diabetes (19% versus 14%, P<0.05), and peripheral vascular or carotid disease (9.5% versus 5.5%, P<0.05) than men. Men were more likely to be treated earlier (within 6 hours) from the time of symptom onset than women (74% versus 63%, P<0.05). Women had a higher incidence of shock or hemodynamic instability than men (25% versus 17%, P<0.05). The unadjusted in-hospital mortality rate was 7.9% in women and 2.3% in men (P<0.05). After multivariate logistic regression analysis, women maintained a 2.3-fold higher risk of in-hospital death compared with their male counterparts (95% confidence interval [CI], 1.2 to 4.6, P=0.016). Conclusions - After correcting for age and baseline risk differences, women undergoing primary angioplasty for AMI have a significantly higher in-hospital mortality rate than men.

Original languageEnglish (US)
Pages (from-to)3034-3038
Number of pages5
JournalCirculation
Volume104
Issue number25
StatePublished - Dec 18 2001

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Angioplasty
Sex Characteristics
Myocardial Infarction
Mortality
Hospital Mortality
Blood Vessels
Shock
Cohort Studies
Retrospective Studies
Logistic Models
Hemodynamics
Regression Analysis
Confidence Intervals
Hypertension
Morbidity
Incidence

Keywords

  • Angioplasty
  • Myocardial infarction
  • Sex
  • Survival

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction. / Vakili, Babak A.; Kaplan, Robert C.; Brown, David L.

In: Circulation, Vol. 104, No. 25, 18.12.2001, p. 3034-3038.

Research output: Contribution to journalArticle

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abstract = "Background - Morbidity and mortality after an acute myocardial infarction (AMI) has been reported to be higher in women than men. However, in some prior reports, women were not treated as aggressively as men, suggesting a treatment bias. We sought to determine whether sex influenced short-term outcomes in a cohort of AMI patients, all of whom underwent primary angioplasty. Methods and Results - We conducted a retrospective cohort study of all patients undergoing primary angioplasty for a first AMI in New York State in 1995. A total of 1044 patients, 317 women and 727 men, were identified. Mean age was 59±12 years in men and 65±12 years in women (P<0.05). Women had a higher prevalence of hypertension (59{\%} versus 44{\%}, P<0.05), diabetes (19{\%} versus 14{\%}, P<0.05), and peripheral vascular or carotid disease (9.5{\%} versus 5.5{\%}, P<0.05) than men. Men were more likely to be treated earlier (within 6 hours) from the time of symptom onset than women (74{\%} versus 63{\%}, P<0.05). Women had a higher incidence of shock or hemodynamic instability than men (25{\%} versus 17{\%}, P<0.05). The unadjusted in-hospital mortality rate was 7.9{\%} in women and 2.3{\%} in men (P<0.05). After multivariate logistic regression analysis, women maintained a 2.3-fold higher risk of in-hospital death compared with their male counterparts (95{\%} confidence interval [CI], 1.2 to 4.6, P=0.016). Conclusions - After correcting for age and baseline risk differences, women undergoing primary angioplasty for AMI have a significantly higher in-hospital mortality rate than men.",
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AB - Background - Morbidity and mortality after an acute myocardial infarction (AMI) has been reported to be higher in women than men. However, in some prior reports, women were not treated as aggressively as men, suggesting a treatment bias. We sought to determine whether sex influenced short-term outcomes in a cohort of AMI patients, all of whom underwent primary angioplasty. Methods and Results - We conducted a retrospective cohort study of all patients undergoing primary angioplasty for a first AMI in New York State in 1995. A total of 1044 patients, 317 women and 727 men, were identified. Mean age was 59±12 years in men and 65±12 years in women (P<0.05). Women had a higher prevalence of hypertension (59% versus 44%, P<0.05), diabetes (19% versus 14%, P<0.05), and peripheral vascular or carotid disease (9.5% versus 5.5%, P<0.05) than men. Men were more likely to be treated earlier (within 6 hours) from the time of symptom onset than women (74% versus 63%, P<0.05). Women had a higher incidence of shock or hemodynamic instability than men (25% versus 17%, P<0.05). The unadjusted in-hospital mortality rate was 7.9% in women and 2.3% in men (P<0.05). After multivariate logistic regression analysis, women maintained a 2.3-fold higher risk of in-hospital death compared with their male counterparts (95% confidence interval [CI], 1.2 to 4.6, P=0.016). Conclusions - After correcting for age and baseline risk differences, women undergoing primary angioplasty for AMI have a significantly higher in-hospital mortality rate than men.

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