Gender differences in in-hospital mortality and mechanisms of death after the first acute myocardial infarction.
BACKGROUND
There are conflicting data about gender differences in short-term mortality after acute myocardial infarction (AMI) after adjusting for age and other prognostic factors. Therefore, we investigated the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI.


METHODS
The data were obtained from a chart review of 3382 consecutive patients, 1184 (35%) women (69.7+/-10.9 years) and 2198 (65%) men (63.5+/-11.8 years) with a first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression.


RESULTS
Unadjusted in-hospital mortality was higher in women (OR 1.77, 95% CI 1.47-2.15). Adjustment that included both age only and age and other baseline differences (hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy) decreased the magnitude of the relative risk of women to men but did not eliminate it (OR 1.26, 95% CI 1.03-1.54 and OR 1.31 95% CI 1.03-1.66, respectively). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications - refractory pulmonary edema and cardiogenic shock (P=0.02) or electromechanical dissociation (P=0.03), and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation (P=0.002). Female gender was independently associated with mechanical death (OR 1.56, 95% CI 1.35-2.58; P=0.01) and anterior AMI was independently associated with arrhythmic death (OR 0.54, 95% CI 0.34-0.86; P=0.01).


CONCLUSIONS
Our results demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-related differences in susceptibility to cardiac arrhythmias following acute coronary events.
Fabijanic
Damir
D
Department of Internal Medicine, University Hospital Split, Spincicev, Split, Croatia. damir.fabijanic@st.t-com.hr
Culic
Viktor
V
Bozic
Ivo
I
Miric
Dinko
D
Stipic
Sanda Stojanovic
SS
Radic
Mislav
M
Vucinovic
Zoran
Z
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy