RESUMO
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