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European Heart Journal 2003 24(11):1024-1034; doi:10.1016/S0195-668X(03)00082-4
Copyright © 2003 by the European Society of Cardiology.
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The impact of gender on the treatment and outcomes of patients with early reinfarction after fibrinolysis: insights from ASSENT-2{star}

Michael C. Tjandrawidjajaa, Yuling Fua, Shaun G. Goodmanb, Frans Van de Werfc, Christopher B. Grangerd and Paul W. Armstronga,* for the ASSENT-2 Investigators

a Department of Medicine, Division of Cardiology, 2-51 Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada
b Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
c Universitaire Ziekenhuizen Leuven, Leuven, Belgium
d Duke Clinical Research Institute, Durham, NC, USA

* Corresponding author. Tel.: +1-780-492-0591; fax: +1-780-492-9486
E-mail address: paul.armstrong{at}ualberta.ca

Received 27 November 2002; revised 14 January 2003; accepted 14 January 2003

Aims To assess gender differences in patients with early reinfarction after fibrinolysis for acute myocardial infarction (AMI) and the impact of these differences on treatment and outcomes.

Methods and results We studied 3.7% of men and 4.8% of women with early reinfarction after fibrinolysis for AMI in the ASSENT-2 trial of 16,949 patients. Women with reinfarction were older and more often had hypertension, diabetes, and major bleeding prior to reinfarction. Despite adjustment for these differences, women with reinfarction were less likely to receive repeat fibrinolytic therapy (OR: 0.55; 95% CI: 0.37–0.84). Aggressive treatment by either repeat fibrinolysis or urgent revascularization was associated with reduced 1-year mortality irrespective of gender. Death within 24h of reinfarction was more frequent in women and accounted for a greater proportion of their 1-year mortality (56.0 vs 34.8%; . The excess mortality in women at 1 year (27.3 vs 19.9%; was eliminated after adjustment for gender differences in baseline risk profile.

Conclusion Women with early reinfarction following fibrinolysis for AMI had more frequent early death and were managed less aggressively. These findings suggest the need for increased awareness and timely intervention in these patients.

Key Words: Gender • Myocardial infarction • Reinfarction • Trials • Fibrinolysis • Revascularization


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