Does the patient's sex influence cardiovascular outcome after acute myocardial infarction?
OBJECTIVE
To determine whether outcome differences based on the patient's sex occur after myocardial infarction (MI) at a large private hospital.


METHODS
We conducted a large cohort study.


METHODS
Inclusion required hospital admission between January 1, 1998, and June 30, 1999, and a diagnosis of acute MI or subendocardial infarction. The number of patients included in the study was 1669. Data were collected at discharge on age, sex, race, health insurance, hypercholesterolemia, diabetes, smoking, hypertension, and the extent of coronary artery disease.


METHODS
The 8 outcomes analyzed were angiogram, angioplasty, stent placement, coronary artery bypass grafting (CABG), mortality, time in the intensive care unit, total length of stay, and combined catheterization procedures.


RESULTS
After adjusting for 7 confounding variables, we found no significant differences between men and women for mortality, ICU time, total hospital time, stent placement, angiogram, angioplasty, or combined catheterization procedures. Men had significantly more CABG (relative risk [RR] 1.96, P <.01). Among patients who underwent CABG (N = 204), men had significantly more 3-vessel coronary disease (RR 1.44, P <.01) and left main coronary artery disease greater than 50% (RR 1.58, P <.01). Once we had controlled for the extent of coronary artery disease, we found no difference between the sexes for CABG.


CONCLUSIONS
During hospitalization after an MI, most cardiovascular outcomes and process measures are the same for men and women. The greater frequency of CABG in men than in women is explained by men's greater frequency of 3-vessel and advanced left-main coronary disease.
Woods
Scott E
SE
Director of Epidemiology, Bethesda Family Practice Residency Program, 4411 Montgomery Rd., Suite 200, Cincinnati, OH 45212, USA. liverdoctor@yahoo.com
Chandran
Prasanna
P
Levin
Linda
L
D000368:Aged; D000704:Analysis of Variance; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000473:pathology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009820:Ohio / Q000453:epidemiology; D012306:Risk; D012737:Sex Factors; D016896:Treatment Outcome