[Why is the in-hospital case-fatality rate of acute myocardial infarction higher in women?].
OBJECTIVE
To assess the influence of age, disease severity at admission and therapeutic interventions on the higher in-hospital case-fatality rate of acute myocardial infarction (MI) in women.


METHODS
A retrospective cohort study involving a total of 388 acute MI patients (50 deaths). The following variables were treated as possible explanatory factors for the association between gender and case-fatality rate of acute MI: age (< 60 vs > or = 60 years), duration of symptoms, Killip class, type of infarction (Q wave vs non-wave), comorbidities, previous history of stroke and specific therapeutic interventions for acute MI (aspirin, beta-blocking drugs, and thrombolytic agents). Logistic regression models were used to assess the influence of potential confounders on the association between gender and in-hospital death.


RESULTS
The in-hospital case-fatality rate of acute MI was higher in women (19.5% vs 9.4%) than in men (odds ratio (OR) = 2.34; 95% CI = 1.12-4.47). Although women were significantly older than men (p < 0.01), the association between gender and death was reduced only by 15 percent after adjusting for age (OR = 1.99; 95% CI = 1.07-3.67). This association became weaker after taking into account disease severity at admission (OR = 1.84; 95% CI = 0.90-3.74) and therapeutic interventions for acute MI (OR = 1.50; 95% CI = 0.67-3.38).


CONCLUSIONS
Differences in age cannot fully explain the higher case-fatality rate in women than in men with acute MI. Severity of disease at admission and differences in therapeutic interventions might play an important role in the higher case-fatality rate of acute MI among women.
Faculdade de Medicina da Universidade Federal da Bahia--Salvador.
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Passos
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Lopes
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Barbosa
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Jesus
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors