Outcomes Similar in Acute Myocardial Infarction Women Treated the Same as Men
Women with acute myocardial infarction (AMI) treated with a reperfusion strategy based largely on percutaneous coronary interventions (PCIs) have outcomes similar to men treated the same way.
“Women with AMI treated with this strategy had a prognosis similar to that of men, despite their significantly older age at presentation,” German researchers say.
They note the female patients also had greater risk profiles because of greater prevalence of diabetes and hypertension.
“Our results suggest that sex alone should not be a factor in deciding whether to perform primary PCI,” they concluded.
The investigators from the Technische Universitat in Munich say a higher mortality risk for women with AMI is a common finding in studies comparing post-infarction outcome in women versus men.
“It is not clear, however, whether sex is an independent predictor of death among patients systematically treated with aggressive reperfusion and medical strategies.”
They studied all 1,937 patients who presented for primary AMI treatment at their centre in the six-year period, 1995 to 2000. Their main outcome measure was mortality at one year after AMI.
“To avoid bias, no selection criteria were applied regarding demographic characteristics, clinical status at presentation, time interval from symptom onset and treatment approach used,” the researchers say.
They say that 26 percent of participants (502 patients) were women.
Approximately 90 percent of the patients had emergency coronary angiography, and 86 percent had primary PCI as a reperfusion strategy.
“Importantly, both women and men received essentially identical therapy with no sex-biased difference in the use of PCI or evidence-based concomitant medical treatment ” use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, etc.
“Considering the high proportion of patients treated with primary PCI, the results of this study should be regarded as representing what might be expected from a systematic interventional approach in the treatment of patients with AMI,” the researchers concluded.
Women patients were older (70 years) than the men (61 years) and had known diabetes or hypertension more often.
“There were no significant differences in one-year Kaplan-Meier death rates with 13.8 percent among women and 12.9 percent among men,” investigators report.
“After age adjustment, women had a lower risk of death (hazard ratio, 0.65).”
JAMA, 2002; 287: 210-215
