Women likelier to die from myocardial infarction than men

Updated: Oct 20, 2012, 20:16 PM IST

Washington: Women are twice more likely than men to die from a myocardial infarction than men, according to new research.

Dr Guillaume Leurent from the Centre Hospitalier Universitaire in Rennes, France said the gender gap in mortality is independent of patient characteristics, revascularisation delays and revascularisation modalities.

Women also had longer treatment delays, less aggressive treatment, more complications and longer hospital stays.

"Previous studies on ST elevation myocardial infarction (STEMI) have shown that women have a worse prognosis, possibly due to longer management delays and less aggressive reperfusion strategies," said Dr Leurent.

"Therefore we used data from ORBI, a prospective registry of 5,000 STEMI patients, to find out whether there were any gender differences in the management of STEMI."

For the current study, the researchers analysed data from 5,000 patients included in the ORBI registry over a 6-year period. They found that 1,174 patients (23.5 percent) were women. Women STEMI patients were older, with an average age of 69 years compared to 61 years for men. Women had more frequent hypertension, less dyslipidemia and less current smoking.

The researchers found significant differences in the management and outcome of STEMI patients according to gender.

Women had longer median delays between symptom onset and call for medical assistance and between admission and reperfusion.

"Delays of management are significantly longer in women, hence they have a longer ischemic time during which the heart``s blood supply is reduced," said Dr Leurent.

"And reperfusion strategies to restore blood flow are significantly less aggressive – with less fibrinolysis, and fewer coronary angiographies performed."

Intra-hospital mortality was higher in women. The researchers used 3 adjustment models to determine whether the higher intra-hospital mortality among women was solely due to gender or whether it was due to other factors such as patient characteristics (age, hypertension, smoking, etc) or management.

Dr Leurent said: "This higher intra-hospital mortality among women significantly persists when adjusted for patient characteristics, for revascularisation delays (onset of symptoms to reperfusion therapy) and for revascularisation modalities."

Women had more STEMI complications including atrial fibrillation and longer hospital stays.

Women received significantly less of the recommended treatments at discharge. Specifically, they received less antiplatelet agents, beta blockers, ACE inhibitors and statins. They also received less cardiovascular rehabilitation.

Dr Leurent said: "These results suggest that women need to be more vigilant about chest pains and request medical help quickly to reduce ischemic time."

He added: "Women may take longer to call an ambulance when they have chest pains because they don``t believe it can be a myocardial infarction. Most women believe myocardial infarction is a male problem."

The study has been presented at the Acute Cardiac Care Congress 2012.