Gender differences in in-hospital mortality and mechanisms of death after the first acute myocardial infarction

There are conflicting data about gender differences in short-term mortality after acute myocardial infarction [AMI] after adjusting for age and other prognostic factors. Therefore, we investigated the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI. The data were obtained from a chart review of 3382 consecutive patients, 1184 [35%] women [69.7 +/- 10.9 years] and 2198 [65%] men [63.5 +/- 11.8 years] with a first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression. Unadjusted in-hospital mortality was higher in women [OR 1.77, 95% Cl 1.47-2.15]. Adjustment that included both age only and age and other base-line differences [hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy] decreased the magnitude of the relative risk of women to men but did not eliminate it [OR 1.26, 95% Cl 1.03-1.54 and OR 1.31 95% Cl 1.03-1.66, respectively]. Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications-refractory pulmonary edema and cardiogenic shock [P=0.02] or electromechanical dissociation [P=0.03], and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation [P=0.002]. Female gender was independently associated with mechanical death [OR 1.56, 95% Cl 1.35-2.58; P=0.01] and anterior AMI was independently associated with arrhythmic death [OR 0.54,95% Cl 0.34-0.86; P=0.01]. Our results demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-re-lated differences in susceptibility to cardiac arrhythmias following acute coronary events

Predictors of type and site of first acute myocardial infarction in men and women

The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction [AMI] differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular events has been observed, particularly between men and women. Therefore, we investigated the relationship between age, gender, and risk factors and location of AMI and the presence of Q waves in ECG. Data was obtained from a chart review of 2958 patients with first AMI: 770 [26%] patients with non-Q-wave AMI and 2188 [74%] patients with Q-wave AMI. Four clinical groups were formed by predetermined criteria [anterior Q-wave, anterior non-Qwave, inferior Q-wave, inferior non-Q-wave]. A logistic regression was performed to assess independent predictors of AMI type and site. Key findings were: 1] inferior non-Q-wave AMI was more frequent in young women [P<0.001]; 2] inferior Q-wave AMI was more common in young men [P<0.001]; 3] anterior non- Q-wave AMI was more common in older men [P<0.001]. Multivariate analysis revealed that independent predictors of anterior non-Q-wave AMI were age over 65 [P=0.002], male gender [P=0.04] and hypercholesterolemia [P=0.0003], and that predictors of inferior Q-wave AMI were male gender [P<0.0001], smoking [P=0.04] and diabetes [P=0.049]. In the gender-subgroup analyses, age <45 years [P=0.04], hypecholesterolemia [P=0.02] and smoking [P=0.01] were independent predictors of inferior Q-wave AMI whereas age >65 years [P<0.0001] and smoking [P=0.0003] were predictors of anterior non-Q-wave AMI in men. In women, age <45 years [P<0.0001] and smoking [P=0.02] were independent predictors of non-Q-wave AMI and hypercholesterolemia [P=0.02] was a predictor of inferior Q-wave AMI. The link between particular types and the site of AMI and age, gender and risk factors suggest that the importance of pathophysiological mechanisms for onset of AMI differs according to sex and age subgroup