title: Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry).
abstract: There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-adjusted OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart failure more often during their hospital stay. The age-adjusted long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women.
authors.affiliation: Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen, Germany. tobias.heer@planet.interkom.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schiele
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Martin
authors.initials: M
authors.lastname: Gottwik
authors.forename: Ulf
authors.initials: U
authors.lastname: Gieseler
authors.forename: Thomas
authors.initials: T
authors.lastname: Voigtländer
authors.forename: Karl E
authors.initials: KE
authors.lastname: Hauptmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagner
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data