Differences in Thrombolytic Treatment and In-Hospital Mortality between Women and Men after Acute Myocardial Infarction.

Abstract

SUMMARYThere is evidence for gender differences in the treatment and outcome of acute myocardial infarction (AMI). However, little data exist about these differences in patients from the Arab Middle East. Therefore, we studied the influence of patient gender on the presentation, the use of thrombolytic therapy, and in-hospital mortality after AMI in Kuwaiti nationals. This is a retrospective study of all consecutive Kuwaiti patients admitted to the coronary care unit of a university hospital with the diagnosis of AMI between June 1994 and May 1997. A total of 89 women and 267 men were included. Women were older than men and had significantly higher rates of diabetes (72% vs 46%), hypertension (58% vs 33%) and hypercholesterolemia (80% vs 53%). Women were less likely to receive thrombolytic therapy (40% vs 62%, p=0.001). Fewer women were eligible for thrombolytic therapy (50% vs 66%, p<0.05). Of those who were eligible for thrombolysis there was no sex difference in receiving such treatment. The in-hospital mortality among women younger than 70 years was 2.5 times higher than among men in the same age group; while there was no difference in mortality between women and men aged 70 years and older. We conclude that women and men with AMI have different clinical characteristics and outcomes following AMI. There was no gender bias for the use of thrombolytic therapy. The higher in-hospital mortality in younger women, i.e. less than 70 years, compared to younger men, indicates that younger women with AMI should be considered as a high-risk group. (Jpn Heart J 2001; 42: 669-676) Key words: Myocardial infarction, Gender, Thrombolytic therapy, Outcome, Middle East HEART disease is a leading cause of death in Kuwait. In 1995, coronary artery disease was responsible for 15.4% of all deaths among Kuwaitis and 23.6% of all deaths among expatriates. 1) Although coronary artery disease is more prevalent in men, it is the leading cause of death in women as in men. Several studies have assessed sex-based differences in treatment and mortality following AMI. It has From the

Age Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction An Evaluation of the TAMIS-II Data

“…In accordance with previous studies, 1,3,15) the present findings indicate that women and men were different with respect to their baseline backgrounds, which could be a predictor of in-hospital management. Also, among procedural characteristics, a delay in seeking CAG was observed in our study.…”

“…First, the sample size was not as large as that used in previous studies. However, because there is no national database in non-Western countries that can be compared with Western countries, 3) we believe the present study makes a contribution to the knowledge in this field.…”

“…[1][2][3][4] Some studies have demonstrated that women with AMI experience lower rates of revascularization and less success with other treatments than do men, while others suggest there is no significant difference between men and women after adjusting for differences in variables, including complications. Thus, the effect of gender on the in-hospital management of patients with AMI remains controversial.…”

A comprehensive view of sex-specific issues related to cardiovascular disease

“…331,332 Others suggest that women tend to present when they are older and are more likely to have comorbidities that may make them ineligible for certain therapies. 282,333,334 Women are also less likely to receive any type of reperfusion therapy (thrombolysis, angioplasty), 335,336 and elderly women in particular have lower rates of thrombolysis compared with men. 335 These observations have been documented in other regions of the world 337-344 as well as in Canada and the United States (Table 13).…”

Age-related Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction in Japan Tokai Acute Myocardial Infarction Study: TAMIS

“…1,2) In Western countries, it is of concern that women are less likely to undergo acute myocardial infarction (AMI) diagnostic tests and treatments. 1,[3][4][5] Some studies have shown this, while others have suggested that women receive similar degrees of diagnostic tests and treatments for AMI as men. 1,2,4,[6][7][8][9][10] There is still a significant amount of controversy concerning this matter so it has been impossible to come to any definite conclusion.…”