Causes of higher in-hospital mortality in women than in men after acute myocardial infarction.
Clinical, laboratory and cardiac catheterization parameters were reviewed in 355 men and 155 women hospitalized at a tertiary care referral center between February 1987 and December 1991 to analyze why women have a higher in-hospital mortality rate than do men after acute myocardial infarction. Hospital mortality was 21.4% in women and 12.1% in men (p = 0.007). In comparison with men, women were older (63.3 +/- 11.9 vs 60.5 +/- 12.6 years; p = 0.023), had more systemic hypertension (46.5 vs 34.4%; p = 0.001) and higher serum total cholesterol levels (211 +/- 51 vs 197 +/- 49 mg/dl; p = 0.0015), sought medical care later (8.9 vs 5.3 hours; p = 0.026), were referred later (47.7 vs 43.7 hours; p = 0.063) and had more shock (34.8 vs 24.2%; p = 0.013). Logistic regression analysis revealed 5 variables predictive of hospital mortality; age > 65 years, diabetes, shock, non-Q-wave infarction, and not undergoing cardiac catheterization. Gender was of borderline significance in predicting hospital mortality. Cardiac catheterization, performed in 88% of women and 87% of men, showed similar rates of 1-, 2- and 3-vessel disease, and similar characteristics of the infarction-related artery. The differences in hospital mortality between men and women are due to a combination of pre- and in-hospitalization factors in women. The excess mortality is not due to differences in disease severity as evaluated by cardiac catheterization information.
Jenkins
J S
JS
University of Missouri, Columbia 65212.
Flaker
G C
GC
Nolte
B
B
Price
L A
LA
Morris
D
D
Kurz
J
J
Petroski
G F
GF
D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D006328:Cardiac Catheterization; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009203:Myocardial Infarction / Q000401:mortality*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D012769:Shock / Q000453:epidemiology; D016387:Women's Health
D002784:Cholesterol