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European Heart Journal 1997 18(10):1583-1589;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Sex-related differences in eligibility for reperfusion therapy and in-hospital outcome after acute myocardial infarction

A. Cariou*, D. Himbert{dagger},, J.-L. Golmard{dagger}, J.-M. Juliard*, H. Bernamer*, A. Boccara*, P. Aubry* and P. G. Steg*

*Services de Cardiologie A et B, Hôpital Bichat-Claude Bernard Paris, France
{dagger}INSERM U436 and Infomatique Médicale, Hôpital de La Pitié-Salpêtrière Paris, France

revised 17 December 1996; accepted 19 December 1996.

Correspondence: Dr Dominique Himbert, Service de Cardiologie A, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France

Abstract

AIMS: To determine the effect of sex on reperfusion therapy and early mortality after acute myocardial infarction.

MEHTODS: We analysed the characteristics, the reperfusion interventions, and in-hospital mortality in 400 consecutive patients (320 men and 80 women) admitted during the first 6 h of acute myocardial infarction and treated by primary angioplasty, or intravenous thrombolysis with rescue angioplasty.

RESULTS: The differences between men and women were age (57 vs 67 years, P=0·001), systemic hypertension (33 vs 50%, P=0·02), cigarette smoking (79 vs 30%, P=0·0001) and contraindications to thrombolysis (28·5 vs 42·5%, P=0·02). Successful reperfusion of the infarct-related artery was achieved in 84% of patients of both sexes. In-hospital mortality was 7·2% in men and 18·7% in women (P=0·001). Multivariate analysis was performed by linear logistic regression in order to compare several embedded models, using repeated maximum likelihood ratio tests. The best model involved the variables of cardiogenic shock and age. Addition of the variable ‘sex’ did not improve the predictive power of this model (P<0·5).

CONCLUSIONS: During acute myocardial infarction, similar successful early reperfusion rates can be achieved in men and women, despite the lower eligibility of women for thrombolytic therapy. Although in-hospital mortality was higher in women than men, the best predictive model of mortality was the combination of age and cardiogenic shock. Therefore, sex does not appear to be an independent predictor of mortality.

Key Words: Myocardial infarction • sex • age • reperfusion • mortality


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