乌鸦传媒

HOUSTON, Dec. 8-- Mortality for women who had an ST-elevation myocardial infarction was greater than for men in an analysis of nearly 80,000 patients, possibly because of gender-based differences in treatment, said investigators here.

The in-hospital STEMI mortality rate was 10.2% for women versus 5.5% for men (PCirculation, Journal of the American Heart Association.

Initial analysis of both STEMI and non-STEMI data also revealed a difference -- 8.2% versus 5.7% (P
And the women who had early STEMI mortality were also older, had slightly different risk profiles, and had revascularization and reperfusion less frequently than men.

Dr. Jneid said it was difficult to sort out whether the early mortality was due to differences in patient characteristics or in treatment, but it was likely that "both were important contributing factors."

Whatever the cause "women presenting with STEMI appear to be at a high risk of dying in the initial 24 hours and to represent a subgroup of patients in whom prompt and aggressive therapies are warranted."

Dr. Jneid and the Get With the Guidelines Coronary Artery Disease investigators examined the records of the patients, who were treated at 420 U.S. hospitals from 2001 through 2006, to determine how closely evidence-based guidelines were followed and how implementing those guidelines affected outcome.

Among the findings:

• Women were 14% less likely to be given aspirin within 24 hours of hospital arrival than men and 10% less likely to get early beta-blocker treatment.
• Overall, women were 25% less likely to received reperfusion therapy than men -- OR 0.75, 95% CI 0.70 to 0.80.
• When women did receive reperfusion therapy, it was less likely to be timely, with both door-to-needle and door-to-balloon times longer for women than for men.
• After acute treatment, women were less likely to have cardiac catheterization procedures and also less likely to undergo either percutaneous or surgical revascularization following acute MI.

The authors cautioned "that these post hoc findings are exploratory in nature and need confirmation in larger analyses."

Moreover, although women had higher in-hospital mortality, other data suggest that women are more likely than men to survive long enough to make it to the hospital.

As a result, "it is conceivable that such a selection bias might have enriched hospitals with higher-risk AMI women and explained our observed sex differences in risk profiles and mortality rates," they wrote.

The data came only from hospitals that participate in the Get With the Guidelines program, a self-selection bias that may indicate that the data are not fully representative of hospitals nationwide.

Additionally, the authors said they had no "data on predischarge and postdischarge mortality and morbidity" and because the findings were culled from records, they were "dependent on the accuracy of this documentation."

The study was supported by the American Heart Association and Merck/Schering-Plough. Dr. Jneid disclosed that he is a member of the Council on Clinical Cardiology of the American Heart Association and received a research grant from the Council on Clinical Cardiology.

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