The impact of gender on the treatment and outcomes of patients with early reinfarction after fibrinolysis: insights from ASSENT-2.
OBJECTIVE
To assess gender differences in patients with early reinfarction after fibrinolysis for acute myocardial infarction (AMI) and the impact of these differences on treatment and outcomes.


RESULTS
We studied 3.7% of men (n=481) and 4.8% of women (n=189) with early reinfarction after fibrinolysis for AMI in the ASSENT-2 trial of 16,949 patients. Women with reinfarction were older and more often had hypertension, diabetes, and major bleeding prior to reinfarction. Despite adjustment for these differences, women with reinfarction were less likely to receive repeat fibrinolytic therapy (OR: 0.55; 95% CI: 0.37-0.84). Aggressive treatment by either repeat fibrinolysis or urgent revascularization was associated with reduced 1-year mortality irrespective of gender. Death within 24 h of reinfarction was more frequent in women and accounted for a greater proportion of their 1-year mortality (56.0 vs 34.8%; p=0.02). The excess mortality in women at 1 year (27.3 vs 19.9%; p=0.045) was eliminated after adjustment for gender differences in baseline risk profile.


CONCLUSIONS
Women with early reinfarction following fibrinolysis for AMI had more frequent early death and were managed less aggressively. These findings suggest the need for increased awareness and timely intervention in these patients.
Tjandrawidjaja
Michael C
MC
Department of Medicine, Division of Cardiology, 2-51 Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada.
Fu
Yuling
Y
Goodman
Shaun G
SG
Van de Werf
Frans
F
Granger
Christopher B
CB
Armstrong
Paul W
PW
D000368:Aged; D004338:Drug Combinations; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D009204:Myocardial Revascularization; D012008:Recurrence; D012737:Sex Factors; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D004338:Drug Combinations; D005343:Fibrinolytic Agents